Update: December 2018
Since diagnostic methods in the form of ultrasound
research became available for general use in medicine
interesting finds have appeared. Namely: various minor anomalies,
who were not previously diagnosed, and they were not even suspected.
One of these finds is an open oval window.
When does an oval window open is the physiological norm?
The oval window is a hole between the right and left
atrium. It is open only during intrauterine life.
baby Oxygen to the fetus enters through the umbilical cord, the lungs do not
functioning and do not require a lot of feeding blood. Therefore, bye
the pulmonary circulation is closed, part of the blood is discharged from
right atrium to the left through an oval window. The window is covered
valve that functions as a spring door: opens
only towards the left atrium.
But все меняется с рождением baby After the first breath, the lungs
the newborn is cleaned of intrauterine fluid, filled
air, and blood enters them in a small circle of blood circulation. WITH
this minute the work of the oval window is over. In the left atrium
pressure increases, which tightly presses the oval valve
windows to the interatrial septum. It does not give the valve door
once again open and creates conditions for its overgrowing.
Sizes and norms
The closure of the oval window normally occurs in terms of 3
months to 2 years. But in 5 years such a find is considered
WITHогласно статистике 50% здоровых детей в 5 лет и 10–25% взрослых
have this feature. Separately, it is worth noting that she is a vice
is not. ATрачи называют ее МАРWITH – малая аномалия развития
hearts. It distinguishes the structure of the heart from the anatomical norm, but
does not bear an immediate threat to health.
In 1930, T. Thompson and W. Evans examined 1,100 hearts,
the results were as follows: 35% of the surveyed were open
oval window, in 6% of them – 7 mm diameter (half of them children are up to
6 months). In adults, LLC large diameter was found in 3%
Window sizes can be different: from 3 mm to 19 mm (usually up to 4.5
mm). First of all, they depend on the patient’s age and size.
его hearts. Indications for surgical treatment does not depend on
the size of the window, and how much it is covered with a valve and the extent
When does an open oval window become pathological?
WITHамо по себе наличие овального окна не является проблемой. After all
circulatory disorders it does not cause, and only functions
with a strong cough, heavy exertion.
Problems arise in the following cases:
- when a child’s heart increases with age, and the valve does not
is growing. Then the oval window does not cover as tightly as it should.
As a result, blood can penetrate from the atrium to the atrium,
increasing the load on them.
- the appearance of diseases or conditions that increase
pressure in the right atrium, therefore, lead to the opening
valve doors in the direction of the left atrium. These are chronic diseases.
lung, diseases of the veins of the lower extremities, combined pathology
heart, as well as pregnancy and childbirth.
In these cases, constant monitoring and supervision of a physician is necessary,
not to miss the moment of transition from the compensated state
Interestingly, sometimes this feature can make it easier
condition of a person and even prolong his life. It’s about primary
pulmonary hypertension when blood in the pulmonary vessels is under
pressure. This is manifested by shortness of breath, chronic cough, weakness,
fainting. Due to the open oval window, part of the blood from
pulmonary circulation is discharged into the left atrium,
relieving lung vessels and reducing symptoms.
The reasons for the failure of the oval window of the heart
On this account there is not one theory and assumption. But
no valid yet. In the event that the valve does not grow together with
around the oval window, they say about the features of the body. it
confirms the number of random finds during
It happens that the valve is initially small and not fully capable
close a window. The reason for this underdevelopment can be any
factor affecting the formation of fetal organs:
- smoking and drinking mother
- work with harmful and toxic substances
- ecology, stress.
Поэтому открытое овальное окно у детей часто сочетается с
prematurity, immaturity and other pathologies of the intrauterine
As already mentioned, the clinic for this pathology is missing,
and the anomaly itself is detected at random. Complications and
consequences usually do not happen.
WITHочетание открытого овального окна с прочими заболеваниями.
WITHимптоматика появляется при нарушениях гемодинамики (правильного
blood flow through the chambers of the heart). it случается, когда имеются
combined heart disease, for example:
- open arterial duct;
- malformations of mitral or tricuspid valves.
Heart chambers are overloaded, interatrial septum
stretched and the valve cannot perform its functions. Appears
WITHимптомы у детей
- it может проявляться частыми заболеваниями легких и
- During the period of stress (crying, coughing, exercise, bouts
bronchial asthma) the nasolabial triangle area becomes
cyanotic, turn blue lips.
- The child is somewhat lagging behind in physical development, growth. Classes
exercise causes fatigue and inadequate stress
shortness of breath.
- Spontaneous, inexplicable syncope appears. Special
this applies to young people with lower venous diseases
WITHимптомы у взрослых
- WITH возрастом при исследовании обнаруживаются признаки
гипертензии легких, перегрузка правых отделов hearts.
- it, в свою очередь, приводит к изменениям на ЭКГ: нарушению
conduction along the right leg of the His bundle, featured increasing
правых отделов hearts.
- Open oval window in an adult, according to statistics
increases the incidence of migraine.
- Data on the possible development of stroke or heart attack
long. WITHлучай, когда тромб, кусочек опухоли или инородное тело
penetrate from the venous system into the arterial system and clog there
vessel, called paradoxical embolism. Getting into the vessels of the heart,
it causes myocardial infarction. In the blood vessels of the kidney – kidney infarction. AT
cerebral vessels – ischemic stroke or transient ischemic
- Также у взрослых может появиться такой парадоксальный
syndrome like platypnea-orthodeoxia. A person has shortness of breath
when lifting out of bed, and disappears when re-taking
How to determine the open oval window?
Usually, the external examination of the patient does not carry any data for
congenital anomaly. Oval open window in the heart of a child
can sometimes be suspected in the maternity hospital when diffuse
cyanosis of the entire skin. But этот признак нужно
differentiate with other pathologies.
Most often the open window between the atria is found at
проведении УЗИ hearts. It is better to carry out an echocardiography with a doppler.
But при малых размерах окна эти методики не смогут определить
Therefore, the “gold standard” of detection LLC is
transesophageal echocardiography. It allows you to see the window itself,
closing the valve, estimate the volume of shunting blood, as well as
carry out differential diagnostics with atrial defect
перегородки – настоящим пороком hearts.
As an invasive method is also very informative.
angiocardiography. The last two methods are used only in
specialized cardiology clinics.
ATодолазы и открытое овальное окно
If there is a similar abnormality of the heart
types of work becomes life threatening. AT частности, профессия
the diver, the diver is dangerous because during rapid descent to a depth
gases dissolved in the blood, turn into bubbles. They are capable
penetrate the right-left shunt of the oval window into the arteries and
cause embolism, which can lead to death.
For a similar reason, faces with an open oval window are not
are allowed to professional activities related to
overloads. it пилоты, космонавты, машинисты, диспетчеры,
drivers, operators, scuba divers, crew of submarines,
decompression workers. It is also dangerous to engage in amateur
Army and oval window
The presence of an open oval window limits recruitment.
As already mentioned, the load reinforces the right-left shunt, and together
with him and the probability of an accident due to embolism.
ATо время службы солдату предстоит совершать марш-броски,
shooting, drill ATоинская медицинская экспертиза
considers such recruits “at risk” and considers it appropriate
conduct in-depth inspection of such young people. After
подтверждения диагноза, призывник определяется к категории «AT» с
limitation of fitness for military service.
AT настоящее время тактика лечения основывается на наличии или
Treatment ООО при отсутствии симптомов
Therapy is not required. Enough observation by a pediatrician,
a therapist and cardiologist with an assessment of the dynamics of the oval state
windows by ultrasound.
Persons without severe symptoms, but at risk of developing
ischemic attack, stroke, heart attack, disease of the lower veins
limbs, it is recommended to take courses
blood (aspirin, warfarin, clopidogrel).
Treatment ООО при наличии симптомов
Treatment оперативное, направлено на закрытие дефекта
with an occluder device. It is used for marked discharge of blood.
from right to left, with a high risk of paradoxical embolism, as well as in
as a preventive measure when the oval window is open at the divers.
The occluder device is attached to the catheter and through the femoral
вену его вводят в полость hearts. The operation takes place under visual
x-ray control. After того, как катетер вводит окклюдер в
oval window, it opens like an umbrella and tightly closes
hole. The method allows to improve the quality of life of such
AT качестве альтернативы окклюдерам ученые королевской больницы
Bronton from London suggested using special
рассасывающийся patch. It is attached to an oval window, and patch
stimulates the natural healing of tissue deficiencies during
of the month. Затем patch рассасывается. This method avoids
a side effect such as inflammation of the tissues around