When a 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 manifests itself already in an adult, then this is a rather serious pathology that should be immediately eliminated.
What is this?
Many people know that the human heart consists of four chambers: two ventricles and two atria, which are separated by a septum. The unborn fetus has a small opening in this septum, which in medicine is called the oval window.
This open foramen ovale in the fetus is necessary for proper blood circulation before it is born. The lungs of the fetus cannot yet function independently, and therefore it receives blood, which is enriched with oxygen by the lungs of the mother. Therefore, blood does not pass through them. Without getting into the lungs of the baby, it is through the oval window and the arterial duct that the blood is redirected from the right side of the heart to the left. The oval hole is located ininteratrial septum. It performs a kind of door function.
Closing time?
After a baby is born, he immediately inhales air with the first cry, and his lungs straighten and begin to function. The pulmonary circulation also begins to work. Now there is no 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, thanks to this, the valve closes and the oval hole in the heart of the newborn closes. Over time, the window is overgrown with connective and muscle tissue and disappears completely.
But sometimes it happens that the foramen ovale in the child's heart 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 he althy, complete closure of the hole in the septum between the atria occurs from two months to a year. This is despite the fact that its functional closure occurs immediately after birth, after 2-5 hours.
Sometimes, due to certain conditions, such as a valve defect, screaming, crying a lot, tension in the anterior abdominal wall, the foramen ovale does not close. Its presence after the child is 1-2 years old is considered to be a minor anomaly of heart development (MARS). There are cases that the closure of the oval window occurs spontaneously at any time. Among adult patients, this pathology occurs in 15-20% of cases.
Why won't the oval window close?
Today, medicine is not able to give an exact answer to the question of why the open foramen ovale does not close in time. According to ongoing research, the following factors can provoke such an anomaly:
- presence of a newborn heart disease;
- hereditary factor;
- if the mother was ill with infectious diseases while carrying a child;
- when parents abuse alcohol and smoke;
- one or both parents are drug addicts;
- mother has diabetes or phenylketonuria;
- baby born prematurely;
- presence of connective tissue dysplasia;
- mother, when she was pregnant, took lithium, insulin, some antibiotics and other drugs prohibited during pregnancy.
Complications of the anomaly
Such a pathology, in fact, does not really matter. But sometimes at a more mature age, through an open oval hole in the arteries that feed the brain, small blood clots can enter 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 the discharge of blood 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 exertion, infections that last for a long time.
If a person under the age of 55,If a stroke occurs, then the first thing doctors should check is if the patient has an open oval hole in the heart. This anomaly occurs in 40% of stroke patients at a young age. In general, every fourth person has such an innate feature (25%).
Symptoms
If a child has a non-overgrown foramen ovale, then he may not gain weight well, behave restlessly. Usually, the oval hole in newborns is no larger than a pinhead 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 close it completely, then this may cause the child to experience signs of hypoxemia, transient circulatory disorders of the brain, and kidney infarction, myocardial infarction, ischemic stroke and other serious illnesses.
The symptoms of this abnormal phenomenon in newborns are mild or absent. Parents may suspect an open window in the baby's heart by such indirect signs as:
- child has poor appetite and little weight gain;
- paleness or bluishness appears during screaming, crying, bathing or straining;
- baby gets tired quickly and signs of heart failure such as increased heart rate or shortness of breath can be observed;
- child acting restless;
- common inflammatory diseases of the respiratory system;
- in severe cases, there may be fainting.
Muscles may be present when listening to the heart.
Older patients also have no specific complaints, only in some cases, during sneezing, coughing or straining, blue skin, transient dizziness or fainting may be noted.
But it should be borne in mind that such symptoms, in addition to turning blue, are often a normal condition. It is believed that if an open oval hole is combined with a migraine, then when the pathology in the heart is eliminated, headache attacks are significantly reduced. How true this is, scientific research has not confirmed.
Should the pathology be treated?
It is not necessary to close the foramen ovale if the patient does not have any symptoms of an anomaly and it is discovered by chance during an ultrasound examination of the heart. To make sure it's an atrial septal defect or foramen ovale, a transesophageal ultrasound is done.
The foramen ovale should only be closed when the person has had a stroke. It is subject to closure if there is confirmation of blood flow in the right-left direction. For this, a Valsalva test is performed. The oval window is closed using a special device called an occluder.
In young people who have already had a stroke, after closing the abnormal hole, the risk of recurrence of strokes is significantly reduced.
What to do?
There are somerecommendations for people who have an open foramen ovale in the heart. For example, this applies to drivers. Doctors recommend that they stop the car every 2 hours and take a short walk. If a person moves, then the risk of stagnation of blood decreases, and less blood clots form in the veins of the legs. This also reduces the risk of stroke.
If a person has to make a long flight in an airplane, then he is also recommended to get up from his seat every 2-4 hours, and at the same time he should drink water more often.
Diagnosis of disease
Since the pathology in most cases does not manifest specific symptoms, it is usually possible to detect an open foramen ovale only through an ultrasound examination of the heart (echocardiography). Sometimes the specialist who conducts the diagnosis asks the patient to do some exercises or just cough during the examination. This is necessary in order to increase the pressure in the chest. This usually helps to increase the shunting of blood through the foramen ovale from the right atrium to the left. In this way, the doctor will be able to detect the abnormal reset.
If there are any questions about the presence of an ovale window in a patient, then transesophageal echocardiography can be prescribed. It will allow you to get a more accurate idea of \u200b\u200bthe pathology. But this diagnostic method is not prescribed for all patients, since it is expensive, complicated and, moreover, quite painful.
How is the treatment done?
Before you decidethe question of the need for treatment, doctors take into account two factors:
- If there are symptoms and complications, then surgery is recommended for the patient. The size of the defect does not matter.
- If there are no complaints, then there is no need for treatment. This applies equally to children and adults.
Scalpel is not used in surgical treatment. The oval window is closed with a puncture that is made in some large artery. The operation is done with the help of 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 artificial circulation.
Usually during a surgical operation, vessels are used, located in the neck, arm or hips. A vessel is punctured, and then instruments are introduced into it, with the help of which the intervention will be carried out. These are catheters, occluders, stents, balloons, etc.
As a rule, the closure of the open foramen ovale is done only if the patient has 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, an occluder, is inserted through a large artery into the heart of a sick person. This is a device that, falling into the oval hole, opens like an umbrella. It happens on both sides at the same time.openings and thanks to this, the window closes permanently. In most cases, this is the treatment used.
Anesthesia at the foramen ovale
During surgery, adult patients are given local anesthesia. A person can talk with doctors, watch on the monitor how the operation is going. But if the patient has an atrial septal defect and the operation must be monitored using transesophageal ultrasound, then in this case the surgical intervention is performed under general anesthesia. The same applies to children and patients who are very afraid of surgery.
Duration of operation
Usually, if everything goes well, without any complications during the operation, its duration is from one and a half to two hours. But sometimes there are complex anatomical variations, then the surgical intervention takes longer than usual.
How does the implant fit?
For three to six months, the implantable device is covered with endothelium, grows 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 the implants and they do not cause allergic reactions, they are made from a high-tech medical alloy.
Post-operative period
After heart surgery, a person should limit physical activity for 6 months. It is necessary to protect yourself from tonsillitis, respiratory infectious diseases, caries. If, however, the disease begandevelop, then antibacterial drugs should be present in the drug treatment. But this should be done only on the advice of a doctor. The first month after the operation, it is necessary to give up sex for a while.
Disease prognosis
If the pathology has no symptoms, then both in children and adults, it does not pose a threat to the body and does not require restrictions in everyday life. But there are cases when such an anomaly is stratified by various unfavorable factors. It can be hard physical work, heart and lung diseases, and more. Then the defect may gradually increase and as a result, clinical manifestations, as well as complications, may occur.
Almost all (99%) of operated patients recover completely. For prevention, patients who have a patent foramen ovale should consult a cardiologist and have an ultrasound of the heart at least once a year.
