Heart diseases have many varieties, but usually they can be predicted and can be detected in the early stages when it is easier and more effective to treat them. However, a disease such as the non-closure of the oval window in children is very worrying for their parents. Since you can find out about its presence only by conducting a routine examination or when removing an ECG. And this can happen in children of any age, because such an anomaly of the heart may not bother for many years. A person can live in peace with the latent form of this defect, without observing any particular symptoms and without experiencing any inconvenience. And this can continue until serious pathologies of the cardiovascular system appear.
Recently, non-closure of the oval window in children has become increasingly common. This becomes an important problem in the timely diagnosis of this disease. What is the essence of this disease and what danger does it pose in itself in the future, we will consider in this material.
What is the failure of an oval window in the heart?
An open oval window is a pathology of the heart, in which a non-fouling gap appears in the heart wall located between the two atria - left and right. This is normal during embryonic development, but when the baby reaches one year of age, the window is usually completely tightened. On the left side, this gap is covered by a valve, reaching maturation at the time of onset of labor. At this stage, non-closure of the oval window in the newborn is still the norm. At the time when the baby makes his first scream and his lungs open, the increased pressure inside the left atrium closes this valve, which eventually fuses with the wall of the septum between the two atria, and the gap is completely tightened.
When does the growth occur? Does it always happen?
In 40-50% of infants, growth occurs during the first year of life. Although some lasts up to five years. In the case when the valve size is insufficient to overlap the heart gap, there is a non-closure of the oval window, which prevents the isolation of the atria from one another. With this pathology, the baby is diagnosed with an open window in the heart (MARS syndrome). A similar condition of the cardiac window in cardiology is classified as a kind of anomaly of cardiac development. It is defined as a heart defect - non-closure of the oval window.
Complicated cases in children
In some cases, an open window does not entail any dangerous symptoms, and also does not affect the quality of life of the baby. Therefore, it is perceived only as a feature of the individual structure of the heart. If this window is small and there is no discharge of blood through an open valve, such an anomaly is not considered a defect. In the most difficult cases, through the through hole, when the muscles of the heart are contracted, blood is thrown from the atrium into the atrium. Such a violation of cardiac activity, as non-closure of the oval window, is considered a defect with a complication if it is accompanied by other cardiovascular diseases. During physical exertion, coughing or screaming, blood can transfer directly from the atrium of the right to the left, bypassing the lungs. It qualifies as a functioning open oval window. But in some particularly difficult cases, there are defects of the septum or it is completely absent, then this is a serious anomaly, attributed to cardiac defects. If the size of the defects of the septum is more than 5-7 mm, circulatory disorders are possible, which leads to the penetration of blood into the vessels of the brain and stroke.
Pathology in adults
In adults, too, there is such a strange anomaly. Non-closure of the oval window in adults appears in the form of a channel (shunt) between the two atria, and it causes a failure of the cardiovascular function and lungs with sharp changes in blood pressure. This is facilitated by serious physical exertion in people who are engaged in strength exercises in sports - wrestlers, weightlifters, athletic gymnasts. Also at risk are divers and divers who dive to great depths and are at risk of decompression sickness. Still dangerous may be the lack of an oval window for those who are predisposed to thrombophlebitis of the legs and small pelvis. In all these cases, before you begin intense training or exercise, you should be well checked for signs of the disease.
Causes of the appearance of pathology
The reasons due to which there is a lack of oval window have not been thoroughly studied, and therefore their nature is not yet clear. But the most common cause recognized genetic predisposition. As a rule, this anomaly occurs as a hereditary disease and is transmitted from generation to generation through the mother. However, there are many other reasons that can affect the development of such a pathology in the heart. This fairly extensive list includes:
- prematurity of the fetus;
- the presence of congenital heart disease;
- connective tissue dysplasia;
- smoking mother during pregnancy;
- mother's use of drugs or alcohol;
- toxic poisoning during pregnancy with certain drugs;
- regular stress;
- malnutrition during pregnancy;
- problem ecology.
Non-closure of the oval window is classified according to ICD-10 & mdash; The international classification of diseases of the tenth revision, which is generally accepted for coding various medical diagnoses. It is developed and approved by the World Health Organization and consists of 21 classes. One of the atrial septal defects related to Q21.1 is an unprotected or preserved oval opening. Until the disease has developed extensively, the child may not feel any discomfort at all, not to mention the pain. It often happens that a doctor is consulted even when the disease has deeply taken root and it becomes much more difficult to cope with it than at the initial stage. It is very important to monitor the symptoms and pay attention to the unusual symptoms.
Symptoms of the appearance of an open window in the septum of the heart
When certain signs of the disease appear, the doctor can diagnose the non-closure of the oval window. Symptoms of the disease are manifested in such a variety of factors:
- a change in skin color near the nose and lips - are clearly manifested with strong crying or activity of the baby;
- frequent colds and viral diseases;
- inhibited physical and psychological development;
- the presence of noise in the heart;
- periodic fainting;
- cerebrovascular accident;
- the appearance of shortness of breath with increased physical exertion.
Tests for diagnosis. Their essence
Diagnosis of an open window can be made by ultrasound during routine examinations of the newborn. Sometimes pathology can be detected in the first year of life, but more often it is possible only with a thorough examination. In especially difficult cases in cardiology, it is practiced to apply stress tests with an oval window not closed. They are carried out according to a special technique, and the results obtained allow a more qualitative and accurate assessment of the degree of coronary blood flow disturbance, as well as determining the body's ability to adapt.
The essence of stress tests is to take ECG readings not at rest, but with a high load on the heart. An electrocardiogram with a calm patient will show a normal result, but with physical exertion, ischemic changes may occur. To obtain an accurate picture of the state of the heart, the readings are taken after intensive walking or jogging along the treadmill with a change in the angle of inclination and speed. Today in cardiology, tests on a bicycle ergometer are widely used - treadmill tests, which allow you to obtain information about the patient's condition even during exercise. If no abnormalities are found in the heart, the sample is considered negative. If there are signs of coronary disease, the test is positive.
Methods for determining the diagnosis of an open window in the heart
To diagnose heart septal disease, both instrumental studies and an ECG, an echocardiogram Doppler and a conventional one, sounding of the heart cavity and radiography are used. In older patients, the pathology is detected by x-ray, due to which you can notice an increase in the right chamber of the heart and record an increase in blood volume in the lungs. To diagnose newborns, a two-meter transthoracic echocardiography is used, which allows you to visually determine the pathology of the oval window and establish its size. Transesophageal echocardiography is performed for adolescent and older children, as well as adults, if it is with bubble contrast, as well as with a breakdown during straining. The most effective study is heart sounding, but it is also the most aggressive. They perform it before heart surgery and do it in a specialized cardiostation.
Treatment of an open window in the heart
Timely diagnostics allow at the initial stage to reveal the non-closure of the oval window. Its treatment is usually prescribed in the presence of certain symptoms. While the patient does not have any disturbance in the functions of the cardiovascular system, he is not prescribed medication. Preventive measures are simply recommended to him - to organize the correct regimen of the day, regular balanced nutrition, moderate physical activity. Perhaps the appointment of exercise therapy, hardening or spa treatment.
If the patient has complaints of pain in the heart, he is recommended to strengthen the body's vitaminization and the use of restorative drugs to restore the function of the heart muscle. In this case, the patient is limited in stress and is more concerned with the general strengthening part of the treatment.
When there is a risk of thrombosis. What to do?
When the risk of thrombosis is high, and blood is ejected from one atrium to another, there should be constant monitoring by a cardiologist and such treatment is prescribed:
- Admission for the prevention of thrombosis of antiplatelet agents and anticoagulants.
- Endovascular treatment - applying a patch to the right atrium in the window by inserting it through a catheter inserted into the femoral artery. This patch has a stimulating effect on the healing of the window with connective tissue. After a month, the patch will resolve, and the valve will grow together in the septum tissues.
Prevention after surgery
After surgery, the patient is prescribed antibiotics for prevention. During the treatment of non-closure of the opening in the septum, complications are possible, but they are quite rare. An abnormality in the heart wall can provoke a stroke, myocardial infarction or kidney, transient disturbance of blood circulation of the brain. Even if the disease is rare enough, at any visit to the doctor it should be notified that there is an open oval window.
Doctors Forecasts
According to the forecasts of doctors, such patients live quietly with their diagnosis and cases of complications are extremely rare. But for their peace of mind, they need constant monitoring by a cardiologist and periodic examinations for echocardiography. Sports and physical activity must be coordinated with your doctor. With caution, you should approach the choice of a profession or hobby that is associated with serious cardiological and respiratory stress. Surgical intervention is carried out only with the appearance of severe disorders in the respiratory system or in the cardiovascular system.
Conclusion
This article describes the features and symptoms of cardiovascular pathology of the intercardiac septum - a non-growing oval window, which, with heavy loads, can provoke the transfer of blood from one atrium to another. Given the difficulties of diagnosis in the early stages of the disease, it is necessary to pay attention to the peculiarities of the behavior of the newborn, so that in the presence of such a cardiac anomaly, the child will be provided with the correct regimen.