The foramen ovale 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 baby 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 baby's lungs, which are not yet functioning. This is how a stable blood supply to the head, neck, spinal cord and brain occurs.
When a child takes his first breath, his lungs and pulmonary circulation begin to work, and the need for communication between 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 slams the foramen ovale. After a while it starts to grow.connective and muscle tissue and disappears completely. But there are also situations in which the oval window does not close and remains open. Below it will be described how dangerous this condition is, how to correct it in a child and whether it is necessary at all.
What does anatomy provide?
In half of he althy full-term newborns, the foramen ovale anatomically closes with a valve already in the first months of life, and its functional closure occurs as early as the second hour of life. Under certain conditions, it partially remains open. Such conditions include valve defect, strong crying, screaming, tension of the anterior abdominal wall. If the foramen ovale remains open after one or two years of age, it is considered a minor anomaly of heart development (MARS syndrome). In some cases, it can close at any other time and absolutely spontaneously. In adults, this case is observed in 15-20%. Due to the popularity of this anomaly, this problem has become relevant for cardiology, and it requires monitoring.
Reasons
The exact reasons why the foramen ovale may not close have not yet been established, but there are some studies that do. that this anomaly could be provoked by these factors:
- congenital heart disease;
- heredity;
- parental addiction;
- smoking and excessive drinking during pregnancy;
- maternal viral infections during pregnancy;
- diabetes mellitus or phenylketonuriamother;
- premature baby;
- connective tissue dysplasia;
- medication during pregnancy (antibiotics, phenobarbital, lithium, insulin).
How does foramen ovale appear in children?
Symptoms
The normal size of the oval window in a newborn is no more than the head of a pin. It is securely covered with a valve that does not allow blood to be dumped from the pulmonary circulation into the large one. If the foramen ovale is 4.5–19 mm open or not completely closed, then the child will show signs of hypoxemia, transient circulatory disorders of the brain. Serious diseases such as renal infarction, ischemic stroke, myocardial infarction, paradoxical embolism may develop.
In many cases, an open foramen ovale in children is asymptomatic or mild. Implicit signs of this anomaly in the structure of the heart, by which parents may suspect its presence, may be as follows:
- poor appetite and poor weight gain;
- appearance of pallor or a sharp bluing with strong crying, screaming, straining or bathing a child;
- fatigue with signs of heart failure (shortness of breath, increased heart rate);
- lethargy or restlessness while feeding;
- fainting (in severe cases);
- baby's predisposition to frequent inflammatory diseases of the bronchopulmonary system;
- the doctor can detect the presence of "noises" during the examination, listening to toneshearts.
Possible Complications
In extremely rare cases, an uncovered foramen ovale can cause the development of a paradoxical embolism. Such 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 foramen ovale. Together with the blood flow, emboli can penetrate into the vessels of the brain, which will cause manifestations of a stroke or cerebral infarction. Such conditions can be fatal. Such a complication may appear spontaneously, and any injury or prolonged bed rest during serious illness contributes to this.
How can a newborn's foramen ovale be diagnosed?
Diagnosis
In order to confirm the diagnosis, the child must be examined by a cardiologist, which is based on the results of an ultrasound of the heart and an ECG. Newborns or young children undergo transthoracic Doppler echocardiography, which allows you to get a two-dimensional picture of the interatrial wall and valve movement time, determine the size of the foramen ovale, or exclude the presence of a defect in the septum.
After the diagnosis is confirmed, and other heart pathologies are excluded, the child should be placed under dispensary observation. He will definitely need to undergo a second heart ultrasound every year to assess the dynamics of the anomaly.
Treatment
If there is no pronounced violation of hemodynamics and symptoms, then the oval window in the heart in children can be considered the norm, only it is necessaryconstant monitoring by a cardiologist. Doctors advise the parents of such a child to spend a lot of time outdoors, carry out exercise therapy and hardening procedures, adhere to the rules of a he althy balanced diet and the necessary daily routine.
Medical therapy can be indicated for children who have signs of heart failure, have a transient ischemic attack (tremor, asymmetry of mimic muscles, fainting, convulsions, nervous tic), and also if there is a need to prevent paradoxical embolism. They can be prescribed vitamin-mineral complexes, funds for additional nutrition of the myocardium (Elkar, Panangin, Ubiquinone, Magne B6).
The need to eliminate the open foramen ovale in a child depends on the volume 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 disorder, then surgical treatment of the oval window in newborns is not required in this case.
Operation
In case of a clear violation of hemodynamics, it may be necessary to perform a low-traumatic operation for transcather endovascular closure of the foramen ovale with a special occluder. Such a surgical intervention is carried out under the control of endoscopic and radiographic equipment. During the operation, a special probe with a patch is inserted into the right atrium through the femoral artery. It closes the gap between the atria and activates its overgrowth.connective tissue. After such an intervention, it is necessary to take antibiotics for six months. And then the patient will be able to return to a normal lifestyle, no longer having any restrictions. So the oval window is perfectly treated in adults as well.
Forecast
Most parents worry that a so-called hole in the heart will threaten their child's life. 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 about the existing restrictions, for example, it will not be possible to engage in various types of extreme sports or choose professions where there will be a high load on the body. It is also very important to take the child to see a cardiologist and conduct annual examinations with ultrasound.
If the foramen ovale hasn't closed after the child's fifth birthday, then it is likely that it will never heal and the baby will be with him for the rest of his life. At the same time, such a pathology does not affect labor activity in any way. It can become an obstacle only for the professions of a pilot, astronaut, diver or sports activities, such as wrestling or weightlifting. Such a child at school will be listed in the second he alth group, and in the drafts of boys into the army he will be assigned to category B (restrictions in military service).
Embolism is rare in childhood complications of open foramen ovale.
There are times whenthe presence of such an uncovered foramen ovale can improve he alth. This can be observed with primary pulmonary hypertension, as a result of which, due to increased pressure in the pulmonary vessels, shortness of breath, chronic cough, fainting, and dizziness occur. Through the oval hole in the heart, the blood from the small circle passes into the large one and the vessels, thus, are unloaded.
Open foramen ovale in adults
In adults, this is an anatomical feature of the structure of the heart. According to statistics, in adults (in 30% of all cases) it leads to the development of various diseases of the cardiovascular system or lung pathology.
The main reason for this situation is an increased indicator of intracardiac blood pressure. Since the development of this problem begins even in the prenatal period of fetal development, in adults, PFO is considered a heart defect.
