When the child is still only in the womb, an oval hole is opened in his heart. This is the right phenomenon for a fetus that has not yet appeared in this world. However, when this is already evident in an adult, then this is a rather serious pathology, which should be immediately eliminated.
What it is?
Many people know that the human heart consists of four chambers: two ventricles and two atria, which are separated by a septum. An unborn fetus has a small hole in this septum, which in medicine is called an oval window.
Such an open oval opening in the fetus is necessary for proper blood circulation before it is born. The fetal lungs cannot yet function independently, and therefore it receives blood, which the mother’s lungs enrich with oxygen. Therefore, blood does not pass through them. Without getting into the baby's lungs, it is through the oval window and arterial duct that blood is redirected from the right heart to the left. An oval hole is located in the interatrial septum. It performs a kind of door function.
When does it close?
After the baby is born, he immediately inhales the air with the first cry, and his lungs are straightened and begin to function. The pulmonary circulation also begins to work. Now there is no longer a need for communication between the right and left atria. During the first cry and inspiration, the pressure in the left atrium becomes greater than in the right. And most often due to this, the valve closes and the oval hole in the heart of the newborn closes. Over time, the window overgrows with connective and muscle tissue and disappears completely.
But sometimes it happens that the oval hole in the heart of a child remains open. Is such a pathology dangerous and what to do in this case?
According to statistics, in half of newborns who were born full-term and healthy, complete closure of the opening in the septum between the atria occurs from two months to a year. This despite the fact that its functional closure occurs immediately after birth, after 2-5 hours.
Sometimes, due to certain conditions, for example, a valve defect, a scream, severe crying, tension of the anterior abdominal wall, an oval opening is not closed. Its presence after the child is 1-2 years old is considered to be a small heart development abnormality (MARS). There are times when the oval window closes spontaneously at any time. Among adult patients, this pathology occurs in 15-20% of cases.
Why does not the oval window close?
To give an exact answer to the question of why in time there is no closing of the open oval hole, today medicine is not able to. According to research, the following factors can provoke such an anomaly:
- the presence of a newborn heart disease;
- hereditary factor;
- if during the bearing of the child the mother was ill with infectious diseases;
- when parents abuse alcohol and smoke;
- one or both parents are drug addicts;
- the mother has diabetes or phenylketonuria;
- the baby was born ahead of schedule;
- the presence of connective tissue dysplasia;
- mother, when she was pregnant, took lithium preparations, insulin, some antibiotics and other drugs prohibited during pregnancy.
Complications of anomalies
Such a pathology, in fact, does not have much significance. But sometimes at a more advanced age, through the open oval hole in the arteries that feed the brain, small blood clots can fall from the lower extremities, and this can cause a stroke. The oval window does not increase throughout life. But sometimes there are such conditions when there is an increase in blood discharge from right to left, and in the tissues of the body in this case there is a temporary oxygen starvation. An example of such conditions can be strong physical activity, infections that last for a long time.
If a person who has not reached the age of 55 has a stroke, then first of all, doctors should check if the patient has an open oval hole in the heart. Such an anomaly occurs in 40% of stroke patients at a young age. In general, every fourth person has such an innate feature (25%).
Symptoms
If the child has a non-overgrown oval window, then he may not gain weight well and behave uneasily. Usually, the oval hole in newborns is no larger than the pin head in size, while it is reliably covered by a valve that does not allow blood from a small circle of circulation to be discharged into a large one. If the open oval window has a size of 4.5-19 mm or the valve does not completely close it, then this may cause the child to show signs of hypoxemia, transient circulatory disorders of the brain, and may also develop kidney infarction, myocardial infarction, ischemic stroke and other serious illnesses.
Symptoms of this abnormal phenomenon in newborns are not pronounced or even absent. Parents may suspect an open window in the baby’s heart based on such indirect signs as:
- the child has poor appetite and gains little weight;
- during screaming, crying, bathing or straining, pallor or cyanosis appears;
- the baby quickly gets tired, while you can observe such signs of heart failure, such as increased heart rate or shortness of breath;
- the child behaves uneasily;
- frequent inflammatory diseases of the respiratory system;
- in severe cases, there may be fainting.
There may be noises while listening to the heart.
In older patients, there are also no specific complaints, only in some cases, during sneezing, coughing or straining, blue skin, quick-passing dizziness, or fainting can be noted.
But it should be borne in mind that such symptoms, in addition to turning blue, are often a normal state. It is believed that if an open oval hole is combined with migraine, then with the elimination of pathology in the heart, headache attacks are significantly reduced. As far as this is true, scientific research has not been confirmed.
Should pathology be eliminated?
There is no need to close the oval window if the patient has no symptoms of anomaly and it was discovered by chance during an ultrasound scan of the heart. A transesophageal ultrasound is performed to make sure that this is an atrial septal defect or an oval window.
The oval hole should be closed only when a person has suffered a stroke. It must be closed if there is confirmation of blood flow in the right-left direction. For this, a test of Valsalva is performed. The oval window is closed using a special device called the occluder.
In young people who have already had a stroke, after closing the abnormal opening, the risk of recurrence of strokes is significantly reduced.
What to do?
There are some recommendations for people who have discovered an open oval window in the heart. For example, this applies to drivers. Doctors recommend that they stop the car every 2 hours and take a little walk. If a person moves, then the risk of blood stagnation is reduced, and blood clots in the veins of the legs are less formed. Due to this, the risk of stroke is also reduced.
If a person has to make a long flight on an airplane, then he is also recommended to get up from the seat every 2-4 hours, and moreover, you should drink water more often.
Diagnosis of the disease
Since the pathology in most cases is not manifested by specific symptoms, it is usually possible to detect an open oval hole only through ultrasound of the heart (echocardiography). Sometimes the specialist who conducts the diagnosis asks the patient to perform some exercises or simply cough during the study. This is necessary in order to increase the pressure in the chest. This usually helps to increase blood flow through the oval window from the right atrium to the left. Thus, the doctor will be able to detect an abnormal discharge.
If there are any questions about the presence of an oval window in a patient, then transesophageal ecardiography may be prescribed. It will provide a more accurate picture of the pathology. But such a diagnostic method is not prescribed to all patients, since it is expensive, complex and also quite painful.
How is the treatment carried out?
Before deciding on the need for treatment, doctors consider two factors:
- If there are symptoms and complications, then in this case the operation is recommended to the patient. The dimensions of the defect do not matter.
- If there are no complaints, then there is no need for treatment. This applies equally to children and adults.
Surgical treatment does not use a scalpel. The oval window is closed with a puncture, which is done in some large artery. The operation is done using special very miniature instruments and under the control of x-rays. This method of surgical intervention allows you to correct heart defects without cutting the chest. There is also no need to stop the heart and use cardiopulmonary bypass.
Usually during surgery, vessels are used that are located in the neck, arm, or thighs. A puncture of the vessel is performed, and then instruments are introduced into it with which the intervention will be performed. These are catheters, occluders, stents, cylinders, etc.
As a rule, closing the open oval opening is done only if the patient already had a stroke and doctors cannot prevent its recurrence or transient ischemic attacks with the help of drug therapy. Therefore, a bloodless technique was developed when a special device, the occluder, is introduced through a large artery into the heart of a sick person. This is such a device, which, falling into the oval hole, opens like an umbrella. This happens simultaneously on both sides of the hole and due to this the window closes forever. In most cases, such a treatment is used.
Oval anesthesia
During surgery, local anesthesia is administered to adult patients. A person can talk with doctors, watch on the monitor how the operation is going. But if the patient has a defect in the septum between the atria and the operation must be controlled using transesophageal ultrasound, then in this case the surgery is performed under general anesthesia. The same goes for children and patients who are very afraid of surgery.
Operation duration
Usually, if everything goes fine, without any complications during the operation, its duration is from one and a half to two hours. But sometimes there are complex anatomical options, then the surgery lasts longer than usual.
How does an implant take root?
From three months to six months, the implantable device is covered by the endothelium, germinates through its cells, and it is no longer possible to distinguish it from the tissues that make up the heart. So that the body does not reject implants and they do not cause allergic reactions, they are made of high-tech medical alloy.
Postoperative period
After heart surgery, a person should limit physical activity for 6 months. It is necessary to protect yourself from tonsillitis, respiratory infections, caries. If, however, the disease began to develop, then antibacterial drugs should be present in drug treatment. But this should be done only on the recommendation of a doctor. The first month after surgery, you must temporarily abandon sex.
Disease prognosis
If the pathology has no symptoms, then both in children and in adults, it does not pose a threat to the body and does not require restrictions in everyday life. But there are cases when a layering of various adverse factors occurs on such an anomaly. It can be hard physical work, heart and lung diseases, and more. Then the defect can gradually increase and as a result, clinical manifestations and complications can occur.
Almost all (99%) of the operated patients fully recover. For prevention, patients who have an open oval opening should undergo a consultation with a cardiologist and do an ultrasound of the heart at least once a year.