Open oval window in the heart: the more dangerous, the signs, the diagnosis, the treatment

The gap in the wall between the right and left atrium is an open oval window of the heart. Consider the causes and pathogenesis of this phenomenon, methods of treatment and prevention.

According to the International Classification of Diseases ICD-10, the congenital communication between the right and left atria is included in class XVII: Q00-Q99 Congenital malformations (deformities), deformations and chromosomal abnormalities.

Q20-Q28 Congenital anomalies of the circulatory system.

Q21 Congenital malformations (malformations) of the cardiac septum.

• Q21.1 Atrial septal defect:
  • Defective coronary sinus.
  • Unopened or preserved: oval hole, secondary hole.
  • Defect of venous sinus.

The heart has a complex structure and performs many important functions. The organ is rhythmically contracted, providing blood flow through the vessels. It is located behind the breastbone in the middle section of the thoracic cavity and is surrounded by lungs. Normally, it can shift to the side, because it hangs on blood vessels and has an asymmetrical localization. Its base is turned to the spine, and the tip is facing the fifth intercostal space.

Anatomic features of the heart muscle:

• The heart of an adult person consists of 4 chambers: 2 atria and 2 ventricles, which are separated by partitions. The walls of the ventricles are thickened, and the walls of the atria are thin.
• The left atrium includes the pulmonary veins, and the right at the hollow. From the right ventricle there is a pulmonary artery, and from the left - an ascending aorta.
• The left ventricle and the left atrium are the left department, in which the arterial blood is located. The right ventricle and the atrium are the venous heart, that is, the right department. Between themselves, the right and left parts are separated by a solid partition.
• The left and right chambers are separated by an interventricular and interatrial septum. Thanks to them, the blood from different parts of the heart does not mix with each other.

Incomplete septal overgrowth is a congenital anomaly, that is, a residual element of embryonic development. In fact - a hole between the two atriums, through which during contractions, blood is thrown from one ventricle to another.

The interatrial aperture with the valve develops in utero and acts as a necessary condition for the normal operation of the cardiovascular system at this stage of development. It allows a part of the placental and oxygenated blood to penetrate from one atrium into another, without affecting the undeveloped and non-working lungs. This ensures a normal blood supply to the head and neck of the fetus, as well as the development of the spinal cord and brain.

At the first cry of a newborn there is a lung opening and a significant increase in pressure in the left atrium. Due to this, the valve completely closes the embryonic slot. Gradually the valve tightly fuses with the walls of the interatrial septum. That is, the gap between the right-hand left atrium is closed.

Approximately in 50% of cases, the growth of the valve occurs in the first year of life of the baby, but in some cases by 3-5 years. With a small valve size, the gap does not close and the atria are not isolated. This pathology is classified as MRS syndrome, that is, a small anomaly of the development of the heart. In adults, this problem occurs in 30% of cases.

[1], [2], [3]

Epidemiology

Medical statistics indicate that the open oval window (LLC) in the heart has a prevalence in two age categories:

• In children up to a year this is the norm. In an ultrasound, an anomaly is detected in 40% of newborns.
• In adults, this heart defect occurs in 3, 6% of the population.
• In patients with multiple heart defects, LLC is diagnosed in 8.9% of cases.

In 70% of cases, incomplete septal involvement is detected even in infancy. In 30% of adults, this disorder manifests itself in the form of a canal or shunt that provokes various diseases from the cardiovascular system. In healthy and full-term children, the opening grows by 50% in the first year of life.

[4], [5],

Causes of the open oval window

In most cases, the reasons for an open oval window are associated with a genetic predisposition. As a rule, the anomaly is transmitted along the maternal line, but it can also arise for other reasons:

• Birth of a premature baby.
• Harmful habits of the mother during pregnancy (alcohol, drug addiction, smoking).
• Congenital malformations of the heart muscle.
• Toxic poisoning with medicines during pregnancy.
• Violations of the central nervous system: severe stress and nervous experiences, emotional exhaustion.
• Connective tissue dysplasia.
• Unfavorable ecology.
• Malnutrition during pregnancy.

Very often, pathology is detected in other pathologies of heart development: an open aortic duct, birth defects of the mitral and tricuspid valves.

[6], [7]

Risk factors

Defect of the interatrial septum occurs for various reasons. The risk factors for a pathological condition are most often associated with genetic disorders along the first line of kinship.

The appearance of the disorder is facilitated by:

• Increased physical activity (power sports, diving, weightlifting and others).
• Thromboembolism of the pulmonary artery in patients with thrombophlebitis of the lower extremities, pelvic organs.
• Harmful habits of a woman during pregnancy.
• Toxic poisoning.
• Premature birth.
• Reduced immune status of a woman.
• Bad ecological environment.
• Deficiency of vitamins and minerals in the female body during gestation due to poor nutrition.

In addition to the above factors, the disorder can be triggered by increased pressure in the right side of the heart muscle.

[8], [9]

Pathogenesis

The mechanism of development of the through hole between the atria is associated with a variety of reasons. The pathogenesis of the anomaly is based on the interaction of internal and external factors. In most cases, these are deviations in the formation, that is, connective tissue dysplasia. Violation leads to the involvement of the pathological process of the heart valves, the subvalvular apparatus and the cardiac septum.

During the spreading of the lungs of the newborn and the increase in pulmonary blood flow, the pressure in the left atrium increases, which helps to close the gap. But connective tissue dysplasia hinders this process. If primary pulmonary hypertension is diagnosed on this background, the pathology has a favorable prognosis, which increases the life expectancy of the patient.

Hemodynamically insignificant open oval window

The movement of blood through the vessels is related to the difference in hydrostatic pressure in different parts of the circulatory system. That is, blood moves from high pressure to low. This phenomenon is called hemodynamics. An open gap in the wall between the right and left atrium is located at the bottom of the oval hollow on the inner left wall of the right atrium. The hole has small dimensions from 4, 5 mm to 19 mm and is usually slit-shaped.

A hemodynamically insignificant open oval window is an anomaly that does not cause blood flow disorders and does not affect the patient's health. This is observed if the defect is small and the valve that prevents the blood shunt from left to right. In this case, people with pathologies are unaware of its presence and lead a normal lifestyle.

[10], [11], [12]

Symptoms of the open oval window

In most cases, the symptoms of an open oval window do not appear. About the presence of pathology a person finds out by chance during a routine examination. But the latent course of the disease has a characteristic symptom complex, which can for a long time remain without due attention:

• Cyanosis and increased pallor of the nasolabial triangle during physical exertion.
• Propensity to catarrhal and bronchopulmonary pathologies of inflammatory nature.
• Delayed physical development.
• Slow increase in weight in the child.
• Poor appetite.
• Respiratory failure.
• Sudden fainting condition.
• Signs of impaired cerebral circulation.
• Frequent headaches and migraines.
• Syndrome of postural hypoxemia.

The presence of the above symptomatology requires careful diagnosis and medical care. If there are various neurological disorders, this can indicate complications of the disorder due to its long course.

First signs

Specific manifestations of congenital communication between the right and left atrium has no. The first signs in most cases remain unnoticed. Suspicion of a problem occurs in such cases:

• Severe headaches and dizziness.
• Blue lips during coughing and any other physical exertion.
• Predisposition to inflammatory lesions of the respiratory system.
• Severe respiratory failure during exercise.
• Fainting condition.
• Varicose and thrombophlebitis of the lower extremities at a young age.

The company has minimal radiologic symptoms, which allow one to suspect an anomaly: an increase in blood volume in the vascular bed of the lungs and an increase in the right heart.

[13], [14]

Open oval window in adults

The main vital organ of any living being is the heart. In humans, it has a complex structure and is responsible for many functions. The organ includes the left / right ventricles and atria connected by special valves. An open oval window in an adult is a pathology most often diagnosed in newborns and premature infants.

In adulthood, an open hole is a shunt. Its presence can cause changes in the cardiovascular system and lungs due to the difference in blood pressure in the atria. But the presence of this anomaly is not always a cause for concern. Very often people live fully and do not suspect about the violation. Only with the ultrasound can identify the problem.

Correct work of the heart and the body as a whole depends on the size of the defect. The size of the hole can be from 2 mm to 10 mm.

• If the window opens 2-3 mm, but is not accompanied by deviations from the cardiovascular system, then this state is not displayed on the functioning of the body.
• If the through hole is 5-7 mm, then this indicates that the disorder is hemodynamically insignificant. Deviation manifests itself only with increased physical exertion.
• If the dimensions are 7-10 mm, then the patient is diagnosed with a gaping open window. On the symptomatology the given kind of illness is similar with a congenital heart disease.

Incompleteness LLC usually does not have specific symptoms. A doctor can only guess at the causes of a painful condition. A comprehensive diagnosis is indicated for the detection of the disorder. It also takes into account the presence at first glance of clinically insignificant symptoms:

• Blueing of the nasolabial triangle in inflammatory diseases and after physical exertion.
• Frequent syncope.
• Violation of cerebral circulation.
• Varicose veins and thrombophlebitis.
• The respite.
• Predisposition to colds.
• Tachycardia.
• Migraine.
• Intolerance to physical activity.
• Increased blood volume in the lungs.
• Frequent numbness of limbs and impairment of body mobility.

This disorder is diagnosed in 30% of people, it is stored from birth. But the risk of developing the disease significantly increases in athletes and with increased physical exertion. The risk group includes: divers and divers, patients with PE (pulmonary embolism) and thrombophlebitis.

Treatment of a painful condition depends on its severity. Many adults are prescribed a set of preventive methods. In especially severe cases, not only drug therapy is shown, but also surgical intervention.

Stages

The open gap in the wall between the right and left atrium refers to cardiovascular defects. The stages of pathology are distinguished by the degree of organ damage and the character of the symptomatology that arises. In medical practice there is such a thing as MARS-syndrome (small anomalies of the development of the heart), which includes this disorder. In the group of pathologies are violations of the development of structures of the external and internal structure of the heart muscle and the vessels adjacent to it.

Incomplete invasion of the septum is included in the general classification of the MRS syndrome:

1. Location and shape.

• Atria:
  • Open oval window.
  • Enlarged eustachian valve.
  • An aneurysm of MPP.
  • The prolapse valve of the inferior vena cava.
  • Trabeculae.
  • Prolubing crest muscles in the right atrium.
• The tricuspid valve is the displacement of the septal flap into the right ventricle cavity, dilatation of the right AV aperture, protrusion of the tricuspid valve.
• The pulmonary artery is the prolapse of the valves of the pulmonary artery valve and the dysplasia of its trunk.
• Aorta - borderline wide / narrow root of the aorta, bicuspid valve, dilatation of sinuses, asymmetry of valve flaps.
• The left ventricle is a small aneurysm, trabeculae, chords.
• The mitral valve.

2. Causes and conditions of occurrence.

• Connective tissue dysplasia.
• Vegetative dysfunction.
• Ontogenesis.
• Disturbances of cardiogenesis.

3. Possible complications.

• Heart rhythm disturbances.
• Pulmonary hypertension.
• Infective endocarditis.
• Disorders of cardiohemodynamics.
• Fibrosis and calcification of valve flaps.
• Sudden death.

Any form or stage of MARS syndrome is an option for visceral connective tissue dysplasia. It is characterized by high frequency of changes from the side of the central nervous system and neurovegetative disorders.

After establishing the type of anomaly, there is a detection of hemodynamic disorders and regurgitation, the degree of their severity. In 95% of cases, hemodynamic disorders and side symptoms do not occur. As they mature, structural abnormalities disappear.

[15], [16]

Forms

Normally, an open oval window is temporary, as it is necessary to saturate the fetus with oxygen during embryonic development. That is an anomaly exists in all children, but by the time of birth it overgrows, as there is no need for additional oxygenation, since the lungs start to work.

Types of incomplete septal involvement depend on the size of the hole:

• 2-3 mm is the norm, which does not cause deviations and consequences.
• 5-7 mm - features of this pathology depend on the presence of concomitant provoking factors.
• > 7 mm is a gaping hole requiring surgical treatment. According to the studies, the maximum size can exceed 19 mm.

In addition to the oval window, there are other defects of the cardiac septum. Their differences are that the window has a valve, which is responsible for regulating blood flow. LLC is not a heart defect, but refers to small anomalies in the development of the cardiovascular system.

Open oval window with reset

In most cases, the through hole between the atria does not cause serious concern. Since the pressure in the left atrium is higher than in the right atrium, the valve between the septa adheres in a closed state. This prevents the discharge of blood from the right atrium to the left. Typically, this is observed with a window size of not more than 5-7 mm.

An open oval window with a reset indicates a large size of the pathology. This is observed with a temporary increase in pressure in the right atrium due to straining, physical exertion, crying or prolonged nervous tension. This condition causes the discharge of venous blood through the LLC, manifested by temporary cyanosis of the nasolabial triangle and blanching of the skin.

The disorder can lead to such a complication as paradoxical embolism. Thrombi, gas bubbles, emboli, foreign bodies from the right atrium after hitting the left atrium and continuing further movement can reach the vessels of the brain. This leads to the development of stroke, thrombosis and heart attacks. To prevent such violations should be a comprehensive diagnosis and timely treatment.

[17]

Open oval window with left-right reset

A short channel between the right and left atrium, covered by a valve and with abnormal blood circulation is an open oval window with a left-right discharge. Normally, fluid discharge occurs in one direction - from right to left. Ltd. Is a physiological feature of the body, which is necessary in the period of embryonic development. But after birth, the need for it disappears and the gap grows, as the lungs begin to work.

There are such types of functioning of the oval window:

• Without hemodynamic discharge.
• With the right-left reset.
• With left-right reset.
• With bidirector shunting.

LLC with a left-right discharge of blood indicates that the pressure in the right atrium is less than in the left. The main causes of this form of disorder include:

• Perforation of the oval window flap.
• Valvular Deficiency in Expansion of the Left Atrial
• Insolvency of the valve.

The right-left vent when the pressure in the right atrium is greater than in the left is due to such reasons: prematurity and low body weight, increased physical exertion and psychoemotional disorders, neonatal pulmonary hypertension, respiratory distress syndrome.

Open oval window with no signs of embolic activity

An open oval window is a valve post between the atria. In the embryonic period, it is responsible for the passage of arterial blood into the left atrium from the right, without affecting the undeveloped vessels of the lungs. Most people close the company after birth, but 30% remains open, causing various pathological symptoms.

With this small anomaly of the heart, there is a high risk of paradoxical embolism. Pathology leads to the fact that small gas bubbles and thrombi fall into the left atrium and through the left ventricle with blood flow to the brain. Blockage of the vessels of the brain provokes a stroke.

An open oval window without signs of embolic activity and other pathologies can be regarded as a variant of the normal structure of the heart. But in the presence of provoking factors (physical activity, exertion, cough), pressure in the right atrium increases and a right-left shunt arises that causes paradoxical embolism.

Complications and consequences

The absence of timely diagnosis and treatment of the through-hole of the atrium is the main cause of the development of various consequences and complications. Patients can face such problems:

• Heart rhythm disturbances.
• Violation of cerebral circulation.
• Pulmonary hypertension.
• Paradoxical embolism.
• Fibrosis and calcification of valve flaps of the heart muscle.
• Violations of cardiohemodynamics.
• A heart attack.
• Stroke.
• Sudden death.

According to medical statistics, the above complications are extremely rare.

Is it dangerous to open the oval window?

Many specialists attribute an innate communication between the right and left atriums to the norm. It is dangerous whether the open oval window depends entirely on the patient's overall health and the presence of concomitant pathologies.

If the window is small, then usually it is not a cause for concern. The patient is prescribed regular examinations at the cardiologist, annual planned heart ultrasound and a set of preventive measures. In the presence of concomitant diseases, LLC can cause serious changes in the cardiovascular system. This is due to the transfer of blood from the right atrium to the left, bypassing the lungs. In this case, any physical strain can cause various complications.

This congenital anomaly is dangerous by the development of embolism. This is a condition where thrombi, gas bubbles and bacterial microorganisms get from the venous blood into the arterial blood, and through the left heart in the arteries of the internal organs. In this case, coronary arteries, kidneys, spleen, limbs can be affected. Heart rhythm disturbances are dangerous for strokes and heart attacks.

[18]

Diagnostics of the open oval window

Small anomalies of the heart are characterized by a latent, that is, a latent flow. To suspect a pathology it is possible at presence of characteristic symptomatology or during planned inspection of an organism. Diagnostics of an open oval window is performed by such methods:

1. Gathering anamnesis - the doctor questions about the presence of genetic abnormalities among relatives, about the course of pregnancy, the harmful habits of a woman and the medical treatment performed during pregnancy, the degree of physical activity of the patient.
2. External examination - this method is ineffective, as the LLC does not always make itself felt by clearly expressed symptoms. But blueing of the nasolabial triangle during crying and straining, pallor of the skin, poor appetite and lag in physical development, allow one to suspect the disorder.
3. Laboratory studies - to date, there are no genetic tests that would identify the MRS syndrome in newborns. Patients are assigned such tests:

• General and clinical analysis of blood.
• Gene mutation of prothrombin.
• Prothrombin time.
• Factor V (Leiden).
• Determination of the level of homocysteine and antithrombin.
• Determination of protein C and protein S

4. Instrumental studies - for the diagnosis of auscultation, that is, listening to the chest for systolic noises. Patient is assigned ultrasound of the heart, echocardiography, angiography, MRI and a set of other procedures.

During the diagnosis, the doctor conducts nutritional assessment, identifies eating disorders and the symptoms of anomalies associated with a disturbance in the balance of nutrients consumed. Ecological features of the patient's living environment are also taken into account.

Noise with an open oval window

One of the methods for diagnosing a through-hole between the atria is listening to the chest with a phonendoscope. With the work of the cardiovascular system, peculiar tones arise. The heart pumps blood, and the valves regulate its direction.

• Before the heart contraction, the valves between the atria and the ventricles close.
• Blood from the left ventricle falls into the aorta, and from the right into the pulmonary artery. When this occurs, a tone is formed.
• The tone occurs when the valves are closed, if an obstacle and many other factors form in the heart.

Noise at an open oval window of the heart can not always be detected with a phonendoscope. This is due to the fact that the pressure difference between the atria is small, so the vortex flow characteristic of the anomaly may not form.

Noise in the heart happens: soft, rough, blowing. All the noise is divided into these groups:

• Pathological - often act as the first, and sometimes the only sign of cardiovascular anomalies.
• Healthy - associated with the features of growth of the chambers and vessels of the heart, the peculiarities of the structure of the organ.

To determine the nature of the noise and the reasons for its occurrence, the doctor conducts echocardiography and ultrasound. These methods allow to evaluate the structure of the heart and surrounding vessels and tissues.

[19], [20]

Instrumental diagnostics

Examination of the body with the help of special equipment is an instrumental diagnosis. If suspicion of incomplete infection of the septum of the heart, such studies are shown:

• Radiography - determines possible cardiac dysfunction caused by increased blood pressure in the right ventricle due to a defect of the interatrial septum.
• Ultrasound of the heart - is carried out to determine the boundaries of the LLC and its dimensions. It is prescribed for newborns and older patients.
• Echocardiography - is carried out with suspicion of various heart abnormalities. It allows to reveal a pathology even at its latent current. It is carried out in two states: after physical exertion and with tranquility.
• Transthoracic two-dimensional echocardiography - allows to reveal the inferiority of the oval window valve in newborns. Visualizes the movement of valve flaps, determines the speed and volume of blood flows from one atrium to another.
• Cerebrospinal echocardiography is prescribed for suspected anomalies in older children and adolescents. During the study, the endoscope is immersed in the esophagus, maximally approaching it to the heart muscle. To obtain more reliable results, bubble contrasting can be prescribed.
• Sounding the heart is one of the most accurate, but aggressive methods of diagnosis. It is most often used before surgery. The procedure is the advance of the probe along the arterial blood flow to the heart for its detailed visualization.

Based on the results of instrumental diagnostics, a final diagnosis can be made or additional studies can be made.

Open oval window on ultrasound

Ultrasound examination of the cardiovascular system is one of the instrumental methods for detecting both congenital and acquired anomalies among newborns and patients of an older age.

An open oval window on ultrasound is characterized by such symptoms:

• Increased right heart chamber.
• Small hole sizes - from 2 to 5 mm.
• Displacement of the main septum between the atria towards the right atrium.
• Thinning of the walls of the interatrial septum.

With the help of ultrasound can visualize the valves in the cavity of the left atrium, assess the overall condition of the organ and the volume of blood flow, localization and other features of the pathology.

Echographic signs of an open oval window

Echocardiography is a diagnostic method using ultrasound waves. It is used to study and determine the localization of internal organs and structures.

Echographic signs of an open oval window can be detected immediately after birth with the help of such studies:

• Contrast echocardiography - identifies LLC or atrial septal defect of the smallest size. For diagnosis, the patient is given an intravenous injection with saline. In the presence of a gap, the smallest air bubbles will penetrate through it from the right atrium to the left.
• Transthoracic two-dimensional echocardiography (Echocardiography) - visualizes not only the opening, but also the functioning flapper. This method is especially informative in newborns and patients of early childhood.

In addition to the above methods, esophagous echocardiography with bubble enhancement may be prescribed to determine the echographic signs of the disorder.

[21], [22]

Dimensions of the open oval window

It is possible to suspect small heart anomalies with the help of a characteristic symptomatology, which very often proceeds in a latent form. The size of the open oval window and the presence of concomitant diseases affect the severity of pathological signs of the disease.

The open gap in the wall between the right and left atria may have such dimensions:

• 2-3 mm - is considered the norm and does not cause any symptoms or complications.
• 5-7 mm is a small anomaly size. With the action of certain factors causes a number of unpleasant symptoms that can progress without medical diagnosis and treatment.
• 7 mm or more is a large or gaping window that requires prompt treatment. In rare cases, it can reach maximum dimensions - more than 19 mm.

According to the research, approximately 40% of adults have a closed aperture between the atria. The average gap is 4.5 mm. If the window remains completely open, then a defect of the interatrial septum is diagnosed, for which, in contrast to LLC, the absence of an operating valve is characteristic.

[23],

Open oval window 2, 3, 4, 5 mm

Congenital communication between the right and left atria is very often diagnosed in preterm infants and slightly less often in healthy children. Open oval window 2, 3, 4, 5 mm - is considered the norm, but under the influence of certain factors can cause pathological symptoms.

Dimensions of the hole more than 5 mm flow with the characteristic features that allow you to suspect a violation:

• Blueing of the nasolabial triangle with physical activity, crying, screaming.
• Slowing of mental and physical development.
• Loss of consciousness and dizziness.
• Fast fatiguability.
• Noises in the heart.
• Various violations of the respiratory system.
• Frequent colds.

The appearance of the above symptomatology is the reason to immediately consult a cardiologist. After a set of various diagnostic measures, the doctor will prescribe the treatment and give recommendations for the correction of the disease.

Differential diagnosis

Abnormal valvular communication between the atria requires a comprehensive examination and, if necessary, treatment. Differential diagnosis of an open oval window is performed with pathologies with similar symptoms.

First of all, differentiation is necessary with other interatrial communications:

• Defect of the interatrial septum.
• Aneurysm of the interatrial septum.
• Hemodynamic discharge disorders.

Let us consider in more detail the differences in the congenital communication between the right and left atriums and the defect of the interatrial septum:

	Ltd	DEMP
Echocardiography	Overlapping of the primary and secondary partitions. Formation of a shunt of interatrial communication.	Deficiency of valve tissue.
Anatomical features	Insolvency of the valve of the oval aperture or atrial flapping.	Absence of a greater or lesser part of the secondary septum.
Discharge of blood	In 95% left-right shunting, with decompensation - right-left shunting. The hemodynamic significance of a discharge of blood is not determinative.
Dimensions	They are of no fundamental importance.

 

Based on the results of the research, the doctor makes a final diagnosis or appoints additional examinations / analyzes.

Treatment of the open oval window

Such a small anomaly of the heart as a through hole between the atria requires special attention. Treatment of an open oval window depends on many factors:

• Dimensions and clinical significance of the cracks.
• Shunting fluctuations during physical exertion.
• Particularities of the septum (increased elongation, loss of contractility).
• The degree of increase in pressure in the pulmonary artery.
• Increase of the right heart.
• Risk of embolic / cerebral complications.
• Presence of concomitant diseases.
• General condition of the body.

The tactics of treatment are completely based on the presence or absence of symptomatology LLC:

1. In the absence of symptoms, therapy is not required. The patient is recommended to observe the therapist / pediatrician and cardiologist, periodic assessment of the dynamics of the condition of the anomaly using ultrasound. If there is a risk of complications (stroke, heart attack, ischemia, lesions of the veins of the lower extremities), the patients are prescribed medications for dilution of blood (Warfarin, Aspirin and others).
2. In the presence of pain symptoms, it is shown not only medicamental, but also surgical treatment. With a marked discharge of blood from the right to the left and the risk of embolism, the defect is closed by an occlusive device or a special absorbent patch.

Elkar with an open oval window

One of the methods of treatment of MARS-syndrome is drug therapy. Elkar, when the oval window of the heart is open, is prescribed from the first days of the disease. Let's consider more detailed the instruction of the given preparation and features of its application.

Elkar is a drug used to correct metabolic processes in the body. The composition of the drug includes L-carnitine - an amino acid that is similar in structure to the vitamins of group B. It participates in lipid metabolism processes, stimulates enzymatic activity and secretion of gastric juice, increases resistance to physical stress.

The active component regulates the consumption of glycogen and increases its stores in the liver and muscle tissues. It has pronounced lipolytic and anabolic properties.

• Indications for use: improvement of the condition of premature babies and newborns after birth injuries, asphyxia. Assigned with a weak sucking reflex, low muscle tone, poor development of mental and motor functions, with insufficient body weight. The drug is used in the complex therapy of chronic gastritis and pancreatitis, with dermatological diseases. Accelerates the recovery of the body with intense physical and psychoemotional stress, with reduced performance and increased fatigue.
• Dosing: The drug is taken orally 30 minutes before meals. Dosage and treatment are individual for each patient, therefore they are determined by the attending physician.
• Side effects: single cases of dyspeptic disorders, myasthenia gravis, gastralgia, systemic allergic reactions were recorded.
• Contraindications: hypersensitivity to the components of the drug. If the drug is prescribed for patients under 3 years of age, then careful medical supervision is required. It is not used for treatment of pregnant women and during lactation.
• Overdose: myasthenia gravis, dyspeptic disorders. There is no specific antidote, therefore symptomatic therapy is indicated.

Elkar is available in the form of a solution for oral administration in vials of 25, 50 and 100 ml with a dosing device.

[24]

Do I need to operate an open oval window?

Faced with such a diagnosis as a through hole between the atria, many patients are wondering: is it necessary to operate an open oval window? The need for surgical intervention is determined by the size of the gap, the presence of concomitant diseases, painful symptoms and other features of the body.

Medicine claims that up to two years, LLC is the norm. The patient should be observed at the cardiologist and annually pass an echocardiogram, ultrasound of the heart. If after reaching the adult age the window is not closed, the patient is placed on strict account with the cardiologist, who decides on the method of treatment of the defect. The doctor takes into account the fact of the development of complications: thrombosis, pulmonary insufficiency, paradoxical embolism, ischemic and cardioembolic stroke.

If the oval window is large, there is no valve (atrial septal defect) or a stroke was transferred, then surgery is a direct indication.

[25]

Surgery

One of the most effective methods of eliminating an LLC is surgical treatment. It is carried out at any age, but only if there are such indications:

• Severe hemodynamic disorders.
• High risk of complications.
• Severe pain symptomatology.
• The diameter of the defect is more than 9 mm.
• A throw of blood in the left atrium.
• Limited physical activity caused by pathology.
• Contraindications to taking medications.
• Complications from the cardiovascular and respiratory systems.

The main purpose of the operation intervention is to close the defect with a patch. The procedure is carried out through the femoral or radial artery with a special endoscope and with the introduction of contrast.

Surgical treatment is contraindicated in pathological changes in the tissues of the lungs and in the absence of the left ventricle. As a rule, the operation is performed after reaching 2-5 years, when the window should be physiologically closed, but this does not happen. Each case is individual and requires a comprehensive comprehensive diagnosis to assess all possible risks of the operation.

Operation with an open oval window

The only and most effective method of treating the fetal heart residual in adult patients is surgery. With an open oval window, such surgical interventions can be prescribed:

1. Open heart surgery.

Through the incision in the chest, the surgeon disconnects the heart from the vessels. Functions of the heart takes on a special apparatus that pumps blood through the body and enriches it with oxygen. With the help of coronary suction, the doctor clears the organ from the blood and makes an incision on the right atrium to eliminate the defect. The method has such indications:

• The hole is more than 10 mm in diameter.
• Severe circulatory disturbance.
• Intolerance to physical activity.
• Frequent catarrhal and inflammatory diseases.
• Pulmonary hypertension.

To close the gap most often use such methods:

• Sealing - a hole in the interatrial septum is sutured. The same manipulations are performed with secondary defects located in the upper part of the septum.
• Imposition of a patch made of synthetic tissue, pericardium (flap of the outer shell of the heart) or a special plaster. This method is used for primary heart defects located closer to the ventricles in the lower part of the septum.

After surgery, the doctor sutures the incision and connects the heart to his blood vessels. The incision on the thorax is closed with a suture.

The advantages of such an operation are in high accuracy of performance and rapid restoration of impaired blood circulation in the lung and the entire body, as well as the ability to eliminate defects of any size and location. The drawbacks of the method include: the need to connect the device for artificial circulation, traumatism due to a large incision of the chest, a long recovery period - about 2 months and rehabilitation up to 6 months.

2. Endovascular surgery (closure of a defect with a catheter).

These are less traumatic operations that do not require opening of the chest. Indications for conducting:

• The window is less than 4 mm in the central part of the interatrial septum.
• The throw of blood from the left atrium to the right.
• Increased fatigue.
• Shortness of breath with physical activity.

During the operation, the doctor inserts the catheter into the holes in the large vessels of the groin or neck area. The endoscope is advanced into the right atrium. At the end of the device is fixed a special device for closing the window:

• Buttons - on both sides of the atrial septum discs are installed, which are connected together by a nylon loop.
• The occluder is a special device resembling an umbrella. It is injected and opened in the left atrium, blocking the transfer of blood from it.

The advantages of such a minimally invasive treatment are: low risk of complications, the possibility of under local anesthesia, a significant improvement in the condition immediately after surgery, a short recovery period - about a month. The main disadvantage of endovascular surgery is that it is not effective in large defects and in the narrowing of blood vessels. The operation is not performed at the window at the bottom of the septum or at the mouths of the hollow / pulmonary veins.

Regardless of the surgical intervention chosen, most patients recover completely after surgery. There is also an increase in life expectancy by 20-30 years.

Indications for occluder

If drug therapy is not able to eliminate pathological symptoms or complications of MARS syndrome, then surgery intervention is indicated. Many patients are assigned endovascular operations, that is, the introduction into the heart through a vein or large artery of a special device, most often an occluder.

Basic indications for occluder:

• LLC is small in size.
• Localization of the defect in the central part of the interatrial septum.
• Increased fatigue and other symptoms of pathology.

With a small heart anomaly, the blood from the left atrium falls into the right and then to the right ventricle and pulmonary artery. This leads to stretching and overloading of these parts of the heart. Normally, the left and right parts of the organ are separated by a thin wall, which prevents the dropping of blood. That is, the main indication for the use of the occluder is precisely the increase and overload of the right heart.

The occluder is an umbrella or a miniature mesh. Using a catheter, it is inserted into the femoral vein and placed at the entrance to the left atrium. Implantation is carried out using an X-ray system that visualizes the entire operation process.

The occluder is made from a biologically inert material that does not cause rejection reactions and is well established in the body. Six months after the operation, the device is endothelialized, that is, it is covered by the cells of the heart. In rare cases, after treatment, patients face complications such as shortness of breath and chest pain.

Prevention

Special methods that would prevent incomplete infection of the cardiac septum do not exist. The prevention of an open oval window is based on a healthy lifestyle and the following recommendations:

• Refuse bad habits (smoking, alcoholism, drug addiction).
• Adhere to a rational and balanced diet that will provide the body with a complex of essential vitamins and minerals.
• Timely treatment of any diseases.

Particular attention to the prevention of anomalies should be given to women who plan to have a baby and are already pregnant:

• Avoid infectious diseases. Especially dangerous is rubella, as it provokes LLC and other congenital malformations.
• Avoid contact with ionizing radiation, such as X-ray machines, fluorographs.
• Do not contact chemicals and their vapors (paints, varnishes).
• Take any medications only for medical use.

There are also preventive recommendations for patients who have already diagnosed an anomaly: a balanced diet, adequate sleep and rest, limited physical activity and regular preventive examinations at the cardiologist.

[26],

Forecast

With timely treatment, the implementation of all medical recommendations and observation by a cardiologist, the forecast of an open oval window is quite favorable. The outcome of an anomaly depends on what kind of therapy was prescribed and how effective it is.

Another important prognostic factor is the functional state of the heart muscle. If there was an operation and it was successful, then there are high chances to avoid consequences and complications. This improves the defect prognosis. For example, endovascular occlusion of LLC allows you to return to normal life for a short period of time, without any restrictions.

Without timely diagnosis, medical or surgical treatment, the prognosis of a small heart abnormality is negative. The risk of serious complications exists at large window sizes, the development of paradoxical embolism and the presence of concomitant diseases.

[27]

Clinical follow-up of children

Abnormal valve communication between the atria requires not only timely treatment, but also medical control. Dispensary observation of children with an open oval window provides for systematic medical examinations and research (ultrasound, echocardiography). This allows us to assess the dynamics of the disorder and the risk of its complications.

Special recommendations are received and parents. The newborn is shown a protective regime with long walks in the open air and full nutrition. This is necessary for hardening the body and increasing the immune defense. Physiotherapy and therapeutic gymnastics are also recommended.

[28], [29], [30], [31], [32],

What professions are contraindicated with an open oval window?

Such a physiological feature as incomplete healing of the septum of the heart, leaves an imprint not only on the way of life, but also on the sphere of activity.

Consider what professions are contraindicated in the open oval window: pilot, diver, diver, scuba diver, driver, engineer, cosmonaut, coffin worker, army officer or submarine crew member. The above specialties can be dangerous for patients.

For example, when lifting or diving, thrombi can form, blocking the vessels and causing death. A caisson works are dangerous because the patient has to breathe compressed air, which also negatively affects the cardiovascular system.

Open oval window and sport

Patients with a congenital through-hole between the atria have many limitations that are aimed at minimizing the risk of developing complications of the disease.

An open oval window and sport are permissible if the defect does not cause abnormal dropping of blood, blueing of the nasolabial triangle due to physical exertion, embolism and other complications. When choosing a sport enthusiasm, the window sizes and the results of the treatment are taken into account.

Open oval window and army

According to the order of the Ministry of Defense of Ukraine of 14.08.2008 № 402, an open oval window and army are incompatible. Patients with this anomaly are partially or completely exempt from military service.

Conscripts from the risk group undergo special military medical examination. On its passage the category is established:

• Limited - the disease proceeds with the discharge of blood, the conscript is not good for service in peacetime.
• It is limited with an anomaly without a discharge of blood, but there are pathological signs of the disorder and the risk of complications.

An open oval window of the heart is a serious congenital pathology. But finally the decision on the possibility of military service is taken by the draft commission.