What is it and why does the window remain open?
In the septum between the right and left atria of the fetus there is an opening covered by a thin valve. It is necessary for oxygenated blood from the placenta to bypass the non-functioning lungs. After birth, the lungs expand, the pressure in the left atrium becomes higher, the valve is pressed against the edges of the opening and gradually increases. In some people, complete fusion does not occur, and a narrow gap remains between the flap and the edge. It opens only when straining, coughing, or intense physical exertion, when the pressure in the right side increases briefly.
- The oval window is the normal structure of the heart before birth.
- Functionally closes in the first days of life
- Anatomical fusion is often completed by 1–2 years
- In adults, an unclosed window is common and usually does not manifest itself in any way.
- This is not an atrial septal defect, although the classification code is general
When is this the norm and when is it a problem?
If the size of the gap is small, there is practically no blood discharge and the chambers of the heart are not dilated, the window is considered a minor developmental anomaly. Such a child does not need restrictions; he can engage in physical education and sports. The finding becomes a problem in two situations. The first is when in fact we are talking about an atrial septal defect with a significant discharge of blood and overload of the right parts. The second is when a blood clot from the veins enters the arterial system through a window, bypassing the lungs. This mechanism has been discussed in adults with stroke for which no cause has been found.
- Minor anomaly - observation and normal lifestyle
- Septal defect - widening of the right chambers, noise, requires treatment
- Paradoxical embolism is a rare but significant situation in adults
- Special attention to divers due to the risk of decompression sickness
- An association with migraine with aura has been debated, but not conclusively proven.
Symptoms and complaints
In the vast majority of cases, a patent foramen ovale does not cause any complaints, and it is found by chance during a routine ultrasound of the heart. In newborns, a transient blue discoloration around the mouth is sometimes noticed when crying and straining; it usually goes away. If a child has shortness of breath, poor exercise tolerance, weight loss, or a heart murmur, the doctor will look not for a window, but for a more significant defect. In adults, the reason for examination is often not a complaint, but a vascular event that has already occurred.
- Most often there are no complaints at all
- Transient blue discoloration around the mouth of a baby when crying
- Fatigue with significant blood loss
- Heart murmur upon auscultation
- Migraine-type headache with aura in some adults
Diagnostics
The main method is echocardiography with Doppler study: the doctor sees the septum, assesses the direction and volume of blood flow, the size of the chambers and the pressure in the pulmonary artery. In newborns and infants, a routine ultrasound through the chest is informative. In adults, the window is less visible, so transesophageal echocardiography and a study with the introduction of contrast from a shaken saline solution against the background of straining are used. An ECG and 24-hour monitoring are needed to rule out rhythm disturbances, and if a stroke is suspected, a cardiologist works together with a neurologist.
- Echocardiography with Doppler is the main method
- EchoCG in newborns and children
- Transesophageal echocardiography in adults
- Contrast study with bubbles and straining test
- ECG and Holter monitoring according to indications
- Ultrasound of the leg veins and examination by a neurologist for a stroke of unknown cause
Observation and treatment
If the window is small and there are no complaints, treatment is not required - repeated echocardiography at an interval determined by the cardiologist is sufficient. No drugs or procedures speed up the closing of the window, so suggestions to “take a course for your heart” are baseless. There is no need to limit a child’s physical activity without indications. The issue of closing a window with a special device through a vessel is considered mainly in adults after a stroke, the cause of which has not been found, and is decided jointly by a cardiologist and a neurologist. The choice of tactics and any medications are prescribed only by a doctor.
- Dynamic observation and repeated echocardiography
- Normal load regime in the absence of indications for restrictions
- Endovascular closure with an occluder - according to strict indications
- Discussion of profession and diving with a cardiologist
- Control of risk factors for thrombosis in adults
