Open oval window in newborn children and adolescents

Quite often diagnosed pathology is an open oval window in a newborn. The cardiovascular system of the child is very weak, but his vital activity requires her to work hard. When the baby cries, sulks or coughs, the blood pressure in the right atrium rises. To reduce it, the body opens an oval window.

Complete closure of the anomaly occurs up to two years, but in some cases it is diagnosed at an older age. From a medical point of view, the danger is not in the hole itself, but in such situations:

• As the child grows up, his heart grows, but the valve does not increase. Because of this, it is unable to completely close the gap, causing blood flow between the atria.
• Violation leads to a number of other pathologies on the part of the cardiovascular system. Most often, this is increased pressure in the right atrium and the opening of the valve.

The causes of the appearance of a defect are associated with such factors: premature birth, diabetes maternal, hereditary predisposition, transmitted infectious diseases during pregnancy, or severe intoxication. The problem also arises from the harmful habits of a future mother: smoking, alcoholism, drug addiction.

For a painful condition in a newborn is characterized by the presence of such symptoms:

• During a cough or crying around the mouth, there is a bluishness that goes away when the baby is in a calm state.
• In the heart of listening to extraneous noise.
• During feeding, the heart rate is rapid.
• Poor appetite.
• Insufficient weight gain.
• Delayed physical development.
• Uncaused loss of consciousness.

To confirm the diagnosis, the newborn should be examined by a cardiologist. The doctor will hold a baby ultrasound of the heart, ECG and transthoracic Doppler Echo-KG. The given researches allow to receive a two-dimensional image of an interatrial septum and movement of valves, to estimate the sizes of Open Company and to exclude presence of other defects. If the diagnosis is confirmed, then a dispensary observation with annual ultrasound of the heart is made to assess the dynamics of pathology.

If hemodynamic disorders are absent, the treatment consists of general health and wellness procedures: balanced nutrition, daily walks in the fresh air, tempering the body. With minor deviations from the cardiovascular system, medication and vitamin therapy can be prescribed to support the normal functioning of the heart and the body as a whole.

In rare cases, the defect of the interatrial septum causes such complications: paradoxical embolism, infarction or stroke of the brain and others. As a rule, up to two years, this pathology does not cause serious problems and completely overgrows by five years.

[1], [2], [3]

Discharge of blood with an open oval window

All newborns have an open oval window of the heart. As the child grows up, the valve closes and overcomes the connective tissue, so that the anomaly disappears. But sometimes the hole closes partially or does not overgrow. In this case, there is a risk of various serious consequences.

The discharge of blood with an open oval window may be violated in such cases:

• The oval aperture with an enlarged heart cavity is stretched, but the valve is not large enough to cover it.
• If the right atrium blood pressure is higher than in the left because of the dilatation of the interatrial septum, that is, the failure of the valve.

The valves open from the right to the left, causing a blood discharge from left to right or right to left. If the valve functions normally, then with increased blood pressure in the right atrium, there is a cast from one atrium to the other, but in the opposite direction, that is, from right to left. Because of this, the anomaly does not manifest itself at rest and during normal life.

If the right atrial pressure constantly exceeds the left atrial position, then a permanent drop of blood from the right to the left through the open window is possible. Similar is observed in patients with thrombophlebitis of the lower limbs and pelvic organs. If the defect reaches a significant size and the blood is discharged from the left atrium to the right, emergency surgical intervention is required.

[4], [5], [6], [7]

Closing an open oval window

Formed during the intrauterine period, the valve communication between the atria is an open oval window. It provides blood supply to the brachiocephalic region of the fetus. Closing an open oval window occurs immediately after birth:

• The small circle of blood circulation starts, the lungs begin to function fully, providing gas exchange. Thanks to this, the open communication between the atrium is no longer necessary.
• Closure of the valve is due to the fact that the left atrium pressure is higher than in the right. If this does not happen, then pathology develops.

Normally, the full closure of the gap occurs in the first 2-3 months of life, but in some cases the process is delayed to two years, which is also the norm. Sometimes the window closes in 4-5 years or is not completely overgrown. The causes of this condition are associated with various factors, for example, hereditary predisposition, severe pregnancy or poor ecology.

Most often, cardiac defect is detected in premature infants with pathologies of intrauterine development. The problem is diagnosed with a phonendoscope for heart noise or by ultrasound. The disorder may be due to an atrial septal defect, when the valve between the atria does not perform its functions.

If the congenital message does not cause pathological symptoms, then a family doctor, cardiologist and regular echocardiography are recommended. If the anomaly is revealed quite by chance with a planned ultrasound of the heart, then its closure is not carried out. Treatment is necessary for the appearance of pathological symptoms and the presence of the right-left direction of the blood flow.

[8], [9], [10], [11], [12]

Open oval window in preterm

Premature birth, this is one of the reasons for incomplete healing of the septum of the heart in children. Open oval window in premature babies is diagnosed much more often than those born on time. The open aperture acts as a communication between the atria. Through it, the venous blood participates in the circulation, without affecting the lungs, which do not function until the moment of birth. Through the gap, the fetus receives oxygen and develops.

The heart has a septum that divides it into the atria. In the center of the septum there is a depression, under which there is a passage with a valve opening towards the left atrium. The diameter of the open gap is about 2 mm. When the baby is born, the window closes at the first breath. But in medicine, its gradual closure during the first year of life is considered the norm. In some cases, the condition is normalized to 3-5 years.

The main reasons for the development of heart pathology in premature infants:

• Hereditary predisposition on the maternal line.
• Harmful habits of a woman during gestation.
• Underdevelopment of the cardiovascular system of the child.
• Unfavorable ecological living environment.
• Poor and unbalanced nutrition during pregnancy.
• Disorders from the central nervous system.
• Stressful situations and nervous overstrain.
• Intoxication during pregnancy.

The open gap in the wall between the right and left atrium has a number of characteristic features: a bad set of the child's weight, cyanosis of the circumcised triangle, frequent colds of bronchopulmonary nature. As the infant grows up, shortness of breath and rapid heart beat appear.

The presence of a functioning window in the heart of a premature can lead to undesirable complications. So in the period of active growth, when the heart muscle increases in size, the valve remains the same. This leads to the fact that the increased blood flow of the window connector provokes mixing of blood from different atria. Because of this, the load on the cardiovascular system is significantly increased.

In some cases, the disorder is even useful. With the primary signs of pulmonary hypertension, blood from the small circle of the blood circulation moves to the left atrium through an open window. Against this background, the pressure decreases, which has a beneficial effect on the general state of the body.

If the window has small dimensions and is not accompanied by additional pathologies, then drug therapy is not performed. The kid is registered with a cardiologist and his condition is observed. If the moderate size of the opening causes discomfort, then anticoagulants and disaggregants can be prescribed. Large dimensions of the defect are accompanied by a decompensated condition, which requires surgical treatment.

Open oval window in adolescents

Such pathology as an open oval window in adolescents is most often detected accidentally during ultrasound examination of the cardiovascular system. With this anomaly all babies are born, but as they grow older, the physiological feature is eliminated on its own. If the closure did not occur, the disease proceeds in a latent form with a rather meager symptomatology. The disorder is characterized by:

• Lag in development.
• Anxiety and fatigue.
• Dizziness and headaches.
• Reduced endurance.
• Pale skin.
• Blueing of the nasolabial triangle during physical exertion.
• Frequent fainting.
• The respite.
• Propensity to colds.

To diagnose a painful condition, you need to undergo a complex of hardware examinations. The doctor, as a rule, a cardiologist, collects anamnesis of complaints and signs of a defect, evaluates the general condition of the patient. Particular attention is paid to laboratory and instrumental methods of research.

The treatment depends entirely on the nature of the disorder. If the expressed disturbances in the work of the heart are absent, then a set of therapeutic measures is shown to maintain the normal functioning of the organism. With severe symptoms, surgical treatment may be required.

Methods of prevention of LLC does not exist. In order to prevent the disease, it is recommended to adhere to moderate physical exertion, that is not to overexert the body. Also, it is necessary to treat all emerging diseases in a timely manner and not to allow their complications.

Open arterial duct and open oval window

Functioning pathological communication between the aorta and the pulmonary trunk is an open arterial duct. An open oval window provides embryonic circulation, but undergoes obliteration immediately after birth, unlike the duct.

An open arterial or botalla duct is an extension of an additional vessel that connects the aorta and the pulmonary artery. The duct is an important anatomical structure, but after birth and pulmonary respiration, the need for it disappears. Normally, it closes in the first 2-8 weeks of life. In cardiology, this defect occupies about 10% of all congenital heart defects and is most often diagnosed in women.

There are several reasons for the anomaly:

• Premature birth.
• Newborns weighing less than 1750 g.
• Syndrome of respiratory disorders.
• Asphyxia during childbirth.
• Persistent metabolic acidosis.
• Postponed infectious diseases of the mother in the first trimester of pregnancy.

Stages of the open ductus arteriosus:

1. Pressure in the pulmonary artery within 40% of the arterial.

• I - the stage of primary adaptation (the first 2-3 years of life).
• II - the stage of relative compensation (from 2-3 years to 20 years).
• III - stage of sclerotic changes in pulmonary vessels.

2. Moderate pulmonary hypertension - pressure 40-75%.
3. Severe pulmonary hypertension - pressure is higher than 75%, left-right blood discharge is preserved.

For the open arterial duct, the following symptoms are typical:

• Lag behind the child in development.
• Increased fatigue.
• Pronounced pallor of the skin.
• Rapid and irregular heartbeat.
• Interruptions in cardiac activity.
• Tachypnea.

Diagnosis of a painful condition consists of chest X-ray, ultrasound of the heart, ECG and phonocardiography. With high pulmonary hypertension, MRI, aortography and probing of the right heart are performed.

To treat this anomaly, preterm infants undergo pharmacotherapy with the introduction of prostaglandin synthesis inhibitors to stimulate the obliteration of the duct. In severe cases, surgery is indicated. Patients undergo open endovascular surgery.

Even a small arterial duct is associated with an increased risk of premature death. The problem leads to a decrease in compensatory reserves of the myocardium and pulmonary vessels. According to statistics, the average life expectancy in the natural course of the duct is about 25 years. In this case, spontaneous closure of the defect is extremely rare.

Open oval window and atrial septal defect

Congenital heart diseases constitute a significant percentage of other diseases. The open window of the heart and the defect of the atrial septum refer to cardiovascular anomalies. According to medical statistics, about 5 children out of 1000 are born with similar problems. At the same time among preterm children the incidence of pathology is much higher.

Atrial septal defect is a congenital anomaly in which there is a hole in the septum between the right and left atria without a valve. Its presence leads to increased stress on the right ventricle and increased pressure in the pulmonary vessels.

Causes of the violation:

• Genetic factors.
• Postponed during pregnancy: rubella, Coxsackie virus, parotitis.
• Diabetes.
• Harmful habits of the mother: alcoholism, smoking, drug addiction.

Atrial septal defect forms:

• Open oval window.
• Primary defect of the lower part of the septum.
• Secondary defect of the upper part of the septum.

Symptoms of a painful condition appear during the first life of the child. Pathology manifests a bluish tinge of the skin at the time of birth. Fabrics can fade with crying and restlessness. The main signs of the defect are:

• The child is listless and refuses to play.
• With physical exertion or crying, heart rate is greatly increased.
• The baby weakly sucks his chest and has a poor appetite.
• Lag in physical development.
• Pronounced pallor of the skin.

To identify a painful condition, a comprehensive diagnosis is shown. Most often, patients are prescribed a course of drug treatment and physiotherapy. In especially severe cases, surgical treatment is performed.

Aneurysm of the interatrial septum and an open oval window

The complex of congenital malformations and anomalies of heart development includes many diseases. The aneurysm of the atrial septum and the open oval window are the components of the MRS syndrome. They can be diagnosed in both adults and children. Most often, the disorder is detected in premature newborns.

Aneurysm of the interatrial septum (MPP) and LLC refer to small heart anomalies. The protrusion of the wall of the artery is a rare defect, it occurs in 1% of children and as a rule, is asymptomatic. Pathology is isolated, but most often it occurs with other anomalies and LLC. Because of this, the symptoms are very blurred, which complicates the diagnostic process.

• The main causes of protrusion of the wall of the myocardium are associated with the impact of both external and internal factors. These can be stresses, adverse environmental conditions of living, or infections transmitted during pregnancy.
• In children of school age, the disease is associated with the rapid overgrowth of the open window by fibro-muscular tissue, which leads to the sagging of thin walls in one direction or another.
• In adults, an aneurysm occurs after a large heart attack.

There are several types of aneurysms that depend on the deflection of the interatrial septum:

• Deflection in the right atrium.
• Deflection in the left atrium.
• S-shaped protrusion, affecting both sides.

In this case, the direction of sagging does not affect the symptomatology and severity of the course of the defect. Most often, right-sided deviation is detected, since the pressure in the left atrium is higher than the right, so the wall of the heart is deflected in the opposite direction.

The main manifestations of the disorder:

• Cyanosis of the nasolabial triangle.
• Tachycardia.
• Heavy breathing with physical activity.
• Increased fatigue.
• Headaches and dizziness.
• Violation of the heart rate.
• Heartache.
• Inflammatory diseases of the bronchopulmonary system.
• Increased sweating and nausea.
• Subfebrile fever.

The pathological condition can be accompanied by complications, the main of which: intracardiac thrombosis, embolism and blockage of other vessels.

Diagnosis of the aneurysm of the interatrial septum consists of ultrasound and dopplerography. If necessary, echocardiography is performed, as well as a set of laboratory and instrumental studies. For treatment use a set of medicamental and physiotherapy methods.

[13], [14], [15], [16]

Norm of an open oval window

There are several conditions, in which the presence of a small anomaly of the heart acts as physiology. The norm of the open oval window is typical for:

1. For proper blood circulation during the embryonic period, blood swings through the through-hole between the atria. After birth, the need for it disappears, as the lungs begin to work, so the hole gradually overgrows. This is the physiological norm. If the window closes before birth, it will cause many serious complications, the most dangerous of which is right ventricular failure.
2. The company remains uncovered right after birth and this is also the norm. Immediately after birth, the baby takes the first breath and makes a cry, straightening the lungs. Because of the heavy load in the left atrium, the pressure that closes the valve increases. According to medical statistics, about 50% of healthy preterm infants have a similar anatomical feature up to two years, and sometimes more.
3. The residual element of the oval opening of the fetal heart closes gradually. This process is due to the growth of the valve to the pit. The duration of this phenomenon is individual for each organism. In some cases, it is 3-5 years.

If other comorbid disorders of the cardiovascular system are detected during the diagnosis of the organism, then this can also be considered a norm, since the MRS syndrome is a multifactorial pathology. In especially severe cases, the holes are not overgrown, then the company remains open for life.

For more information on how to treat an open oval window, see this article.

[17], [18]