The oval window in the heart is an intrauterine opening, which is covered by a special fold-valve located on the wall between the atria. It separates the left and right atria of the child during the embryonic phase. Thanks to this window, part of the placental blood, which is enriched with oxygen, can move from the right to the left atrium, thus bypassing the lungs of the child, which are not yet functioning. Thus, a stable blood supply to the head, neck, spinal cord and brain occurs.
When the child takes his first breath, his lungs and pulmonary circulation begin to work, and the need for communication of the left and right atria loses its importance. During the first breath and the cry of the baby, the pressure in the left atrium becomes greater than in the right, and in frequent cases the valve closes and closes the oval window. After some time, it begins to overgrow with connective and muscle tissue and disappears completely. But there are situations in which the oval window does not slam and remains open. Below we will describe the danger of such a condition, how to correct it in a child and whether it is necessary at all.
What is provided by anatomy?
In half of healthy full-term newborns, the oval window anatomically closes the valve in the first months of life, and its functional closure occurs at the second hour of life. Under certain conditions, it partially remains open. Such conditions include valve defect, severe crying, screaming, tension of the anterior abdominal wall. If the oval window remains open after one or two years of life, then this will be considered a small abnormality of the heart (MARS syndrome). In some cases, it can close at any other time and is absolutely spontaneous. In adults, this case is observed in 15–20%. Due to the popularity of this anomaly, this problem has become urgent for cardiology, and it requires observation.
Causes
The reasons why the oval window may not close have not yet been established, but there are some studies that are believed. that this anomaly could be triggered by these factors:
- Congenital heart defect;
- heredity;
- parental addiction;
- smoking and excessive drinking during pregnancy;
- maternal viral infections during pregnancy;
- diabetes mellitus or phenylketonuria in the mother;
- prematurity of the child;
- connective tissue dysplasia;
- taking medications during pregnancy (antibiotics, phenobarbital, lithium preparations, insulin).
How does an oval window appear in the heart in children?
Symptoms
The normal size of the oval window in a newborn is no more than the head from a pin. It is reliably covered by a valve that prevents the discharge of blood from the pulmonary circulation to the large. If the oval window 4.5–19 mm in size is open or not completely closed, then the child will show signs of hypoxemia, transient circulatory disorders of the brain. Severe diseases such as kidney infarction, ischemic stroke, myocardial infarction, paradoxical embolism can develop.
In many cases, the open oval opening in children does not have symptoms or the symptoms are dim. Implicit signs of this anomaly in the structure of the heart, according to which parents may suspect its presence, can be as follows:
- poor appetite and poor weight gain;
- the appearance of pallor or a sharp bluish blue with severe crying, screaming, straining or when bathing a child;
- fatigue with signs of heart failure (shortness of breath, increased heart rate);
- lethargy or anxiety during feeding;
- fainting (in severe cases);
- the baby's predisposition to frequent inflammatory diseases of the bronchopulmonary system;
- the doctor can detect the presence of "noise" during the examination, listening to heart sounds.
Possible complications
In extremely rare cases, an unclosed oval window can cause the development of paradoxical embolism. These emboli can be small gas bubbles, blood clots, or small particles of adipose tissue. They can penetrate into the left atrium, then into the left ventricle with an open oval window. Together with the blood stream, emboli can penetrate into the vessels of the brain, which will cause manifestations of a stroke or cerebral infarction. Such conditions can be fatal. A similar complication can appear spontaneously, and any trauma or prolonged bed rest during serious illness contributes to this.
How can I reveal an oval window in the heart of a newborn?
Diagnostics
In order to confirm the diagnosis, the child should be examined by a cardiologist, who is based on the results of an ultrasound of the heart and an ECG. Children with newborns or young children undergo a transthoracic Doppler echocardiography, which allows to obtain a two-dimensional picture of the atrial wall and valve movement time, to determine the size of the oval hole or to exclude the presence of a defect in the septum.
After the diagnosis is confirmed, and other pathologies of the heart are excluded, the child should be placed under medical observation. He will definitely need to undergo a second ultrasound of the heart every year to assess the dynamics of the anomaly.
Treatment
If there is no marked violation of hemodynamics and symptoms, then an oval window in the heart in children can be considered the norm, only constant monitoring by a cardiologist is necessary. Doctors advise parents of such a child to spend a lot of time outdoors, conduct exercise therapy and hardening procedures, adhere to the rules of a healthy balanced diet and the necessary regimen of the day.
Drug therapy can be indicated for children who have signs of heart failure, there is a transient ischemic attack (tremor, asymmetry of the facial muscles, fainting, convulsions, nervous tic), as well as if there is a need for the prevention of paradoxical embolism. They can be prescribed vitamin-mineral complexes, funds for additional myocardial nutrition ("Elkar", "Panangin", "Ubiquinone", "Magne B6").
The need to eliminate an open oval window in a child depends on the amount of blood discharged into the left atrium and its effect on hemodynamics. If there are no congenital concomitant heart defects and there is a slight circulatory disturbance, then surgical treatment of the oval window in newborns is not required in this case.
Operation
If there is a clear violation of hemodynamics, it may be necessary to carry out a slightly traumatic operation for transcatheter endovascular closure of the oval window with a special occluder. Such surgical intervention is carried out under the control of endoscopic and radiographic equipment. During the operation, a special probe with a patch - “patch” is inserted into the right atrium through the femoral artery. It closes the lumen between the atria and activates its overgrowth with connective tissue. After such an intervention, antibiotics must be taken for six months. And then the patient will be able to return to a normal lifestyle, already without any restrictions. So the oval window and in adults is perfectly treated.
Forecast
Most parents worry that the so-called hole in the heart will threaten the life of their child. But in fact, this pathology is not dangerous for the child, and many children with such an open window feel quite well. It is only necessary to remember the existing restrictions, for example, it will not be possible to engage in various types of extreme sports or choose a profession where there will be a high load on the body. It is also very important to take the child to a cardiologist and conduct annual examinations with ultrasound.
If, after the child’s fifth birthday, the oval hole has not closed, then it is likely that it will never overgrow and the baby will be with him for the rest of his life. Moreover, such a pathology does not affect labor activity. It can become an obstacle only for the professions of a pilot, astronaut, diver or playing sports, for example, wrestling or weightlifting. Such a child in school will be included in the second group of health, and in the calls of the boys to the army he will be assigned to category B (restrictions on military service).
Embolism is rare in complications of an oval open window in childhood.
There are times when the presence of such an open oval opening can improve health. This can be observed with primary pulmonary hypertension, which results in shortness of breath, chronic cough, fainting, and dizziness due to increased pressure in the pulmonary vessels. Through an oval hole in the heart, blood from the small circle passes into the large circle and the vessels are thus unloaded.
Open oval window in adults
In adults, this is an anatomical feature of the structure of the heart. According to statistics, LLC in adults (in 30% of all cases), it entails the development of various diseases of the cardiovascular system or lung pathology.
The main reason for this situation is an increased rate of intracardiac blood pressure. Since the development of this problem begins even in the prenatal period of fetal development, in adults LLC is considered a heart defect.