If the oval window has not closed by one year. Congenital heart defect: open foramen ovale. How to treat a patent foramen ovale in infants

What is a patent foramen ovale?

A patent foramen ovale (Figure 1) is a small opening between the right and left atria that normally functions in every fetus. This structure acts as a valve that directs blood from the lower half of the fetus's body to the left side of the heart, bypassing the non-functioning lungs. As the lungs expand with the baby's first breaths, the need for this structure disappears, since now all the blood from the body passes through the lungs and only then enters the left atrium. The pressure in the left atrium gradually increases and several months after birth exceeds the pressure in the right atrium, which contributes to the closure of the oval window in most people.

However, the oval window does not heal and remains open in approximately 25% of healthy adults.

Symptoms

An open oval window is an individual feature and does not manifest itself clinically. The oval window is not considered a heart defect. Patients with a patent foramen ovale can lead their usual lifestyle and physical activity.

Patent foramen ovale and stroke

Under certain conditions, when the pressure in the right atrium again begins to exceed the pressure in the left atrium, the oval window again begins to act as a valve, directing blood from the lower half of the body to the left chambers of the heart. If there is stagnation of blood in the venous system (for example, in the veins of the lower extremities or pelvis), blood clots form there. The latter, together with the blood, can pass through the oval window into the left chambers of the heart, then into the brain and cause a stroke (Video 1).

A patent foramen ovale is found in 25% of adults under the age of 55 who have had a STROKE. In most cases, a patent foramen ovale is often combined with thrombosis of the veins of the lower extremities and a sedentary lifestyle.

Diagnostics

All young people who have suffered a stroke should undergo routine transthoracic and transesophageal ultrasound of the heart and Doppler craniography of cerebral vessels. An ultrasound of the heart confirms or excludes the presence of an oval window, its anatomy (the presence of an aneurysm of the interatrial septum), and shows, using various tests, the direction of blood flow at the level of the oval window.

If, during echocardiography, when the patient strains (Valsalva maneuver), the direction of blood flow from the right atrium to the left is observed, this confirms the fact that the cause of the stroke was a patent foramen ovale.

Ultrasound Dopplerography of the vessels of the head (Doppler craniography) confirms or excludes the entry of small blood clots from the veins of the lower extremities into the vessels of the brain through the oval window.

The presence of an aneurysm of the interatrial septum in combination with a patent foramen ovale increases the likelihood of developing a stroke, since the aneurysm contributes to greater mobility of the septum, which means that more blood clots will be directed through the oval window into the vessels of the brain.

Should a patent foramen ovale be closed?

If the foramen ovale is found by chance during a routine cardiac ultrasound, there is no need to close it. The oval window does not lead to an increase in heart size. It is possible to distinguish a foramen ovale from a small atrial septal defect only with the help of transesophageal ultrasound.

THE OVAL WINDOW SHOULD BE CLOSURED ONLY IF THE PERSON HAS SUFFERED A STROKE. It is closed if the presence of a right-to-left direction of blood flow is confirmed during the Valsalva maneuver.

The oval window is closed endovascularly using a special device - an occluder (Fig. 2, 3).

The technique and device are similar to closure of an atrial septal defect (Video 2).

Closing the patent foramen ovale in young people who have had a stroke SIGNIFICANTLY REDUCES THE RISK OF REPEATED STROKES (Video 3).

Lifestyle in patients with a patent oval window.

If you are a driver and you know that you have a patent foramen ovale, it is recommended to stop every 2 hours for a short walk. An active lifestyle reduces the risk of blood stagnation and thrombus formation in the veins of the lower extremities, and therefore reduces the risk of stroke in patients with a patent foramen ovale.

Video 1: A blood clot travels from the right side of the heart to the left and causes a stroke

Video 2: In this colorful animation you can see how the LLC is closed with an occluder.

Video 3: LLC closed with an occluder (X-ray video).

How is the treatment done?

Myths and reality about endovascular surgery
congenital heart defects

Currently, X-ray endovascular surgery is attracting more and more attention from almost all media, including print media, the Internet and television. Every day we are confronted with a massive flow of information on various aspects of this modern field of medicine. Every day they write and talk about it, but, unfortunately, not everything and not always objectively. There are many erroneous statements, rumors or even myths that need to be corrected with factual information.

Myth 1. This is a very new, almost experimental field of cardiovascular surgery.

This is wrong! Endovascular surgery has a rich history and has long been widely used in medical practice. Cardiac catheterization was first performed in 1929 by R. Forsmann (Germany), for which he received the Nobel Prize in 1956. In 1964, the first balloon angioplasty was performed and since then endovascular surgery has ceased to be a purely diagnostic area of ​​medicine. Further discoveries and inventions of devices followed one after another: 1975 - spirals, 1976 - occluders, 1979 - emboli, 1986 - coronary stents, 1994 - stents for large vessels, 2005 - endovascular heart valves! To date, all of the above devices have evolved to more advanced analogues. The most common occluder in the world has become the Amplatzer occluder - more than half a million implantations since 1995. At the Amosov Institute, Amplatzer occluders have been installing their analogues since 2003. The trend in the world is that diagnostics have moved from the cath lab to echocardiography and computed tomography rooms, and the treatment of heart defects has moved from the operating room to the cath lab. In developed countries of the world (USA, Canada, Australia, Europe), ductus botellus, septal defects, and coarctation of the aorta are practically not operated on surgically. Our institute takes into account all modern global trends when treating patients.

Myth 2. Devices used to treat defects (occluders, coils, stents) are foreign bodies and can be rejected.

All these devices are made of modern high-tech biocompatible materials that do not cause rejection reactions. Six months after the operation, these devices are completely covered with endothelium (they grow with their own cells) and do not differ from the inner surface of the heart. All devices are non-magnetic; after their implantation, the patient can undergo an MRI. They do not beep at metal detectors at airports, shopping malls, etc.

Myth 3. Occluders move (fly away).

Indeed, in our and world practice such cases occur, but their frequency is about 1%. The complication is unpleasant, but not critical. There has not been a single case in the world where a displaced occluder would have led to death. As a rule, such an occluder is removed endovascularly and reinstalled or replaced with a larger one. The greatest number of displacements occurs in the first hours or days after surgery, when the patient is still in the clinic. Further, the probability of this decreases sharply; distant displacements are casuistic.

Myth 4: Atrial septal defects with missing or thinned edges are not amenable to endovascular closure.

The absence of the aortic edge of the septum is not a contraindication to occluder placement. The same applies to a thinned or aneurysmal septum. Remember that conventional (transthoracic) echocardiography does not provide a complete picture of the defect. Even if a diagnosis of absence of a margin is made, this does not mean that it is not there. The clear anatomy of the defect can only be judged after transesophageal echocardiography, which is the gold standard for selecting patients for endovascular treatment.

Myth 5. Occluders require replacement over time.

The device does not need to be replaced either as the patient grows or over time. The occluder grows into the septum within 6 months and creates the basis for its further growth. In the case of vascular stenting, it is possible to endovascularly increase the lumen of the stent with vessel growth without replacing the implant.

Myth 6. It's expensive...

Endovascular surgery is high technology, which really costs more than conventional operations. In some cases, the patient buys the device for implantation, but there is a waiting list for free implants, which are purchased by the institute. In addition, we cooperate with numerous relief funds that, in a relatively short time, raise funds to purchase devices for children. In most cases, there is no urgency in the operation, and patients have enough time to raise funds for the implant, wait their turn, or find a sponsor. Therefore, if a patient wishes to undergo endovascular surgery, there are currently no barriers to this.

FAQ

The average hospital stay is 3-4 days. As a rule, on the day of admission in the morning you undergo an examination, including a clinical and biochemical blood test (you need to arrive on an empty stomach), an X-ray, an ECG, an ultrasound examination of the heart and a consultation with a cardiologist and cardiac surgeon. If all indicators are normal, the next day an operation is performed to eliminate the defect. On the third day, we conduct control tests and discharge you.

To be admitted to our hospital, you will need a passport or a child’s birth certificate.

If the patient is a child, you need a certificate of sanitary and epidemiological conditions (stating that the child has not recently had contact with infected patients), which you will receive at the clinic at your place of residence.

It is advisable to have previous advisory reports, an ECG and a chest x-ray with you.

A referral from a local cardiologist is NOT REQUIRED. You can come for a consultation and subsequent treatment by self-referral. If you are over 30 years old or have experienced interruptions in your heart function, it is advisable to conduct Holter monitoring at your place of residence. Such a study can be carried out here, but this will increase your time in hospital by 1-2 days.

If you suffer from chronic gastritis, gastric or duodenal ulcers, you need to undergo fibrogastroduodenoscopy. If the disease is confirmed, you need to undergo treatment at your place of residence. Such a study can be carried out here, but this will increase your time in hospital by 1-2 days in the absence of ulcers and erosions.

All adult patients undergo surgery under local anesthesia. The patient can observe the progress of the operation and communicate with the staff. The exception is patients with an atrial septal defect, who require transesophageal ultrasound guidance during surgery and, for patient comfort, the operation is performed in a state of medicated sleep. All endovascular operations in children and hypochondriac patients are performed under general anesthesia.

It is necessary to limit vigorous physical activity for 6 months. Prevention of respiratory infections, tonsillitis, and caries is necessary. If the disease begins to develop, antibacterial drugs should be included in the treatment regimen after consultation with a doctor. During the first month after surgery, it is also necessary to limit sexual activity.

The news of such a diagnosis as a patent oval window is alarming, and in some cases frightens people.

What is the peculiarity of this diagnosis and is a patent oval window a pathology?

The essence of the diagnosis

Between the right and left atria there is a wall. There is a gap in it. During the period of intrauterine development of the fetus, this hole is a completely normal and even necessary formation.

Its formation begins approximately 3 weeks after conception. During an ultrasound examination, it can be detected as early as 5–6 weeks. Through it there is blood supply between the body of the mother and the fetus.

The process of blood supply to an adult and a fetus has some differences. In an unborn child, the lungs do not participate in the blood supply. This is compensated by the participation of the pregnant woman’s body in ensuring the blood circulation of the fetus.

At the stage of intrauterine development, the ductus Botallus enters the blood circulation. Through it, the blood flow is directed from the heart to the aorta. In addition, the open foramen ovale is directly involved in the process of blood circulation, through which blood is directed from the right to the left atrium.

After a newborn baby takes his first breath of air, his lungs open, which automatically includes them in the blood circulation. As a result of such changes, the Botal duct and LLC cease to be necessary for the viability of the baby.

Over a period of approximately 1 month to a year, the open oval window is gradually closed by a valve, the halves of which grow to the walls of the window. By the end of the child’s first year of life, a septum is formed at the site of the valve, which separates the right and left atria.

In some cases, the final closure of the patent foramen ovale is completed 5–6 years after birth. There are cases when the open oval window of the heart remains uncovered throughout a person’s life.

Norm and pathology

According to statistics, in approximately 50% of children aged 5–6 years and in 10–20% of adults, the open oval window remains unclosed.

Experts do not consider this a congenital heart defect. This is considered a minor pathology of cardiac development (MACD), which distinguishes the anatomy of the heart from its norm, without posing a threat to human health and life.

In 1930, American scientists examined 1,100 patients who were diagnosed with a patent foramen ovale. The results of these examinations showed that in 6% of patients the window size did not exceed 7 mm. Window sizes can vary between 3–9 mm. As a rule, its dimensions do not exceed 4–5 mm.

What determines the size of the hole? According to experts, its diameter is directly dependent on the age of the person, as well as the size of the heart.

The presence of a window in no way means the need for surgical intervention. Only those patients whose degree of compensation is too low require surgery.

The window begins to function only with heavy physical exertion or severe coughing. Such problems can arise if the child’s heart grows with age, but the valve does not increase in size.

As a result of this, blood can return from the right atrium to the left, which creates a fairly large load on the heart. In this case, a person may develop various kinds of diseases of the cardiovascular system or other systems.

Causes and signs of MARS

The exact reasons for the formation of an open oval window in the interatrial septum are still unknown. But among the factors that can provoke such an anomaly are the following:

• the woman smoked or drank alcohol during pregnancy;
• stressful situations of women;
• influence of negative environmental factors on the pregnant woman’s body;
• direct contact with toxic substances, etc.

That is why in newborns the presence of an open oval window is paired with other pathologies of heart development or prematurity of infants.

Symptoms

As mentioned earlier, in most patients, a patent foramen ovale may only present with minor symptoms.

For example, if we talk about small children, they may notice a slight cyanosis in the nose or lips or pallor of the skin, which tend to appear in children during screaming (crying) or during heavy physical exertion.

As a rule, such children are prone to frequent colds and also gain weight too slowly.

In adolescents, during puberty, hormonal changes in the entire body occur. This in turn provokes an increase in the load on the cardiovascular system.

At this time, the open oval window manifests itself in the form of frequent dizziness, fainting, weakness, and irritability. Interruptions in the rhythm of heart contraction can often be observed.

Experts say that if the LLC is not overgrown in the period from 2 to 5 years, most likely the defect will accompany the person for the rest of his life.

Complications and treatment

If the anomaly does not manifest itself in children, they do not need special treatment. It is enough to periodically conduct a medical examination by specialists. It is advisable to limit the amount of physical activity, follow a daily routine and eat right.

If the pathology manifests itself in the form of minor disruptions in the functioning of the heart or cardiovascular system, the patient may be recommended a course of special medications and vitamins that have a general strengthening effect on the body and the heart itself. Among them are such as Panangin, Elkar, Megne V6, etc.

Surgical treatment of an open oval window is recommended if the symptoms of the window are much stronger and brighter. The patient must be under constant supervision of the attending physician. In addition, he may be recommended a method of endovascular treatment of pathology, which consists of applying a special medical plaster to the window to promote its healing.

In such cases, the patient is also prescribed a course of drug therapy, which consists of drugs from groups such as anticoagulants and antiplatelet agents.

In case of improper treatment of congenital non-closed tumor, which has severe forms of manifestation, there is a risk of developing varicose veins of the lower extremities, myocardial infarction, stroke or cerebral circulatory disorders.

If you adhere to the recommendations of specialists, lead a healthy lifestyle, and eat a balanced diet, then the risk that an open oval window will remind you of itself in the form of signs dangerous to health or life is extremely small.

A disease with the beautiful name “patent foramen ovale” in newborns and children under 5 years of age has recently become widespread. This “window” is an oval hole, up to 3 mm in diameter, located in the middle zone of the septal space between the two atria. The septum divides the two atria in half, representing a natural protection; in its center there is a small depression in the shape of an oval fossa. This “window” is located at the bottom of the recess, supplemented with a valve and can normally close after a certain period. But this does not always happen, so we will consider the open oval window and the method of its treatment in more detail.

In what cases is this normal?

An open foramen ovale in a child’s heart is a normal physiological sign when it heals on its own within 2-5 years. This window is required by the fetus because through it the atria are able to work and connect with each other. With the help of a deepening, blood from the vena cava instantly passes into the systemic circulation, since the fetal lungs do not yet work at full capacity during pregnancy. All children are born with this pathology, and it is always present in infants.

Sometimes the depression closes on its own in a child who has not yet been born, which provokes right ventricular failure and sudden death of the fetus in the womb or after birth. After birth, the baby breathes fully, and the blood circulation of the lungs begins to work. As oxygen flows from the lungs into the atria, they no longer need to connect through the opening, and the window closes after a certain period of time.

Important! Since babies experience great stress, and taking into account their unprepared body, the oval cavity still works: during feeding, if the child cries or screams, the pressure in the right zone of the heart becomes higher.

When venous blood is released through the cavity, the baby’s triangular area under the nose turns blue; this symptom guarantees a functioning oval window. It should close completely by the age of five; the duration of the process depends on the characteristics of the body and manifests itself differently in each child. Usually, the closure of the oval does not occur immediately; ideally, the valve grows to the edges of the recess gradually. In certain cases it closes after a short period of time, in others the process can take several years. .

Symptoms of pathology

An oval window in a newborn is considered normal and most often does not become a cause for concern. But in approximately 20-30% of people, such a hole in the atrium zone does not completely grow together and can remain half-open throughout life. In rare cases, it remains open: the deviation is recognized by ultrasound of the heart and is an atrial septal defect (ASD). Why is the defect dangerous? Will the child have health problems in the future?

Important! A person with an unclosed foramen ovale needs to consult a cardiologist more often; he will be able to quickly identify all abnormalities and prescribe treatment that will prevent complications from occurring.

With septal problems, the working valve typical of a patent oval window is completely absent. But the presence of a hole is not considered a dangerous deviation; it is classified as a small anomaly (MARS). If it has not closed in a child under three years of age, he is included in the second health group. Young people of conscription age with this defect are suitable for military service, but with additional restrictions. Such a depression does not cause problems in life, since it can function when coughing or during physical activity. Difficulties arise:

• when blood passes through the atria, if the oval window in the heart in adults is not completely covered;
• if you have diseases of the lungs or veins in the legs;
• with mixed type heart disease;
• during pregnancy and during childbirth.

Main factors

The reasons that there is an open oval window of 2 mm or larger in the heart are different, they are influenced by the physiological characteristics of the body of each individual person. At the moment, there are no proven scientific theories or assumptions that could fully substantiate and confirm the specific causes of the pathology. When the valve does not fuse with the edges of the oval window, the cause is various factors. Echocardiography or ultrasound of the heart can reveal the presence of LLC .

Sometimes the valve is not able to close the recess completely due to its too small size, which provokes non-closure of the natural oval window. Underdevelopment of the valve is provoked by poor ecology and stress, smoking or drinking alcohol by the mother during pregnancy, or constant contact with toxic components. An open foramen ovale in the heart remains in an adult if developmental abnormalities, slow growth or prematurity are detected in childhood.

Important! In the presence of thrombophlebitis of the legs or pelvic area, some people have increased pressure in the area of ​​the right heart, which subsequently causes the appearance of an open small oval window in adults.

Hereditary causes, dysplasia of connective tissue, defects of the heart or congenital valves can lead to the opening of windows in children at an older age during development. If a child plays sports, he is at risk of developing such a defect, since playing sports seriously affects health. Since the physical loads in gymnastics, athletics or other sports activities are serious, this provokes the appearance of a window.

Signs depending on age

Standard signs in newborns or adolescents are not recorded when an open oval window occurs in the interatrial septum, and the presence of a defect is often discovered by chance, for example: during echocardiography and other diagnostic procedures. The pathology does not threaten serious complications, with the exception of other complex diseases that may affect it. For example: if a child or adult has hemodynamic problems when heart defects are detected, including a mitral or tricuspid valve or ductus arteriosus.

Symptoms of such a defect as a patent oval window appear in both infants and adolescents , in specific cases vary depending on age. When it comes to a child 4-7 years old, the diagnosis in most cases is made during a standard examination by a pediatrician or pediatric cardiologist. Only ultrasound or echocardiography can confirm the presence of a window. You can find out about the presence of a defect in infants by the main sign - blue discoloration of the nasolabial triangular area and lip area during exercise. Other deviations include:

• frequent diseases of the lungs and bronchi;
• noticeable delay in growth and development;
• shortness of breath and excessive fatigue during exercise;
• constant and causeless fainting and dizziness;
• when listening at an appointment with a cardiologist.

In some adults, pathology is accompanied by characteristic symptoms and can be temporary or permanent. Sometimes the functional window opens after overgrowth in the presence of special pathologies, if the pressure in the area of ​​the right atrium gradually increases. An open foramen ovale appears in a pregnant woman, with complex pulmonary insufficiency or when a pulmonary artery is blocked. Despite the almost complete absence of difficulties, deviation can become a problem and provoke:

• pulmonary hypertension and congestion of the right region of the heart;
• difficulties with conduction in the area of ​​the right bundle branch;
• migraine;
• gradual development of a heart attack or stroke;
• short-term shortness of breath.

Diagnostic methods

Before prescribing complex therapy and confirming the pathology, a specialist usually prescribes a diagnosis, as a result of which you can accurately find out about the presence of an oval hole. The standard technique is the method of listening, or auscultation, of the sternum during the examination of the baby: in case of pathology, the doctor records systolic type noises. There are more reliable methods, including ECG and ultrasound.

If parts of the canal do not completely cover the edges of the hole, it is recommended to contact a specialist as soon as possible and undergo a full examination. Imaging through echocardiography is the main technique, it is prescribed to every child who has reached the age of one month, as evidenced by new standards in the field of pediatrics. If a patient has heart defects, he is sometimes recommended to undergo ecocardiography through the esophagus and undergo an angiographic study in a specialized hospital.

Treatment measures

The method of treatment for a child or adult depends on age, the presence of additional pathologies and whether the patient has signs of pathology or not. If there are no symptoms, and the defect is not accompanied by additional problems, the patient’s health does not worsen, you just need to be examined by a pediatrician, therapist and cardiologist. Doctors will be able to assess the condition of the oval depression and take appropriate measures in time and prescribe treatment. If the window does not close naturally before the age of five, corrective medications are prescribed.

Important! When it comes to an oval-type window, the normal size of which does not exceed 5 mm, surgical correction is not required. If there is a large depression, specialists may prescribe surgery together with corrective therapy.

The risk group consists of patients who do not have pronounced symptoms, but are likely to experience ischemia, heart attack, stroke, pathologies of the veins in the legs or other diseases. In some cases, surgery may be required when the oval window is too large in diameter and blood flows into the left atrium. Among the techniques, endovascular type surgery stands out: during the operation, a catheter is inserted into the patient’s thigh vein, which is then passed to the area of ​​the right atrium.

The path of the catheter is monitored using an X-ray machine and an ultrasound probe, which are placed through the esophagus. Then occluders are passed through such catheters, which cover the hole well. This technique also has disadvantages, since occluders can provoke inflammatory processes in the tissues of the heart. There is an additional way to solve the problem, which is a special patch inserted through a catheter, which then opens into the atrium. It regenerates tissue well and dissolves on its own within thirty days.

Preventing complications

The occurrence of complications can cause dangerous conditions, including the risk of thromboembolism; such patients need to study the condition of the veins in the lower extremities more often. Adults with a patent foramen ovale usually receive thromboembolic prophylaxis if surgery is to be performed. Such measures include taking anticoagulants or bandaging the legs, and a number of additional techniques. Often with this problem, symptoms of cardiac conduction problems and blood pressure disorders may occur.

Heart pathologies are a very common problem in newborns. An open foramen ovale in the baby’s heart is a very common diagnosis encountered by parents of a newborn. It is determined using ultrasound of the heart. Of course, this immediately sounds like a death sentence for parents, but is it really that scary? Let's figure it out.

A patent foramen ovale is present in an infant during the period when the child is developing in the womb. At this stage, such an open hole becomes the norm for the proper development of the fetus. When a baby is born, normally this window closes in infants immediately, with the first breath.

The norm is also considered to be the gradual closure of such an opening until the first year of a little person’s life. It often happens that such a window closes before 2.5 years of age, or even before 5 years of age.

This pathology is an unclosed gap in the septum between the right and left atria. After birth, this septum must be completely closed by the heart valve. But as life’s realities show, such a partition still does not close with a valve in half of the planet’s population.

And such a diagnosis is not always a reason for panic and worry. Often people live full lives without even suspecting the presence of such a pathology. You can only find out about it by ultrasound examination.

For the proper functioning of the heart, and the body as a whole, the size of such an open window in the heart matters. The dimensions of such a hole can vary from 2 mm to 10 mm.

1. If such a window opens by 2-3 millimeters, and there are no more cardiac abnormalities, and the person is not worried about anything, then this condition will have practically no effect on the functioning of the body as a whole.
2. If the open septum reaches 5-7 mm in size, this pathology is hemodynamically insignificant. Such a deviation can manifest itself only during periods of strong physical stress on the body.
3. But if the window size reaches 7-10 mm, then the diagnosis will sound like a “gaping open window”, and in terms of symptoms this condition is identical to congenital heart disease, which sounds like an atrial septal defect.

Causes of this heart pathology

1. The most common factor is the child's genetic predisposition. This genetic anomaly is transmitted primarily through the first line of family ties.
2. Mother's bad habits. If a pregnant woman drinks alcohol and smokes tobacco, there is also a high probability that the baby will not close the interatrial septum in time.
3. Bad ecology. If a woman’s pregnancy took place in an unfavorable environmental environment, and if the child grows up in the same environment, this pathology may also appear.
4. Poor and unbalanced nutrition of the expectant mother during the period of bearing a child will also adversely affect the baby’s cardiac system.
5. Constant stressful situations and depression contribute to the development of such deviations.
6. Severe poisoning of a pregnant woman (including drugs).
7. The birth of a child ahead of schedule. A large percentage of premature babies suffer from this disease.

Forecasts for the future

The presence of a small unclosed oval window (3 mm) in the child’s heart will allow him to lead a full life in the future, if there are no second heart diseases. If there are any, then the presence of an open hole will complicate the course of heart diseases, and the very process of treating such diseases.

In the presence of such a pathology, experts do not recommend serious sports activities for the child. Physical activity should also be moderate.

Constant monitoring of the baby's heart condition is necessary. Such monitoring is carried out through ultrasound of the heart, ECG, and, of course, it is necessary to monitor the general physical condition of the child.

Signs of this cardiac abnormality in children

Responsible parents should identify the signs of an open foramen ovale in an infant by the following symptoms:

• The baby is not gaining weight well
• Blue discoloration of the circumlabial triangle. This happens when the baby cries, screams, coughs or strains.
• Frequent colds of a bronchopulmonary nature

In an older period, the child has a risk of shortness of breath and rapid heartbeat, especially during intense physical exertion.

In adolescence, the disease expresses itself as follows:

• fatigue, fatigue, even without much physical activity;
• headaches of unknown etiology;
• weakness, dizziness, loss of consciousness;
• disruptions in the proper functioning of the heart muscle;
• frequent respiratory diseases, colds

What should you be wary of with this pathology?

The presence of a functioning window in the heart can create a number of undesirable complications, in such cases:

1. The period of active age-related growth of a child. At such a moment, when the heart muscle grows rapidly, and the valve remains the same size, increased blood flow is possible in the connector of the hole, when blood freely penetrates from one atrium to another. This situation increases the load on the atria.
2. Particular vigilance should be exercised in the presence of diseases that increase pressure in the right atrium. Such diseases contribute to additional opening of the valve towards the left atrium.

There are cases when such cardiac pathology is even beneficial for the body. This is the presence of primary signs of pulmonary hypertension.

In such a situation, blood from the pulmonary circulation moves through the open window into the left atrium, thus reducing pressure, which has a beneficial effect on the general condition of the body.

Treatment method for this cardiac abnormality

If the open window is not large in size, and there are no additional heart diseases in the child, then in this case, the child does not need any medications or manipulations. You can limit yourself to regular observations from a specialist.

If the moderate size of the open hole causes discomfort in the child’s body, it is possible to prescribe anticoagulants and antiplatelet agents.

If the oval window is too large and causes decompensated conditions in the child, surgical intervention is necessary.

In any case, for any course of this disease, regular monitoring by a doctor is necessary. Medicines must be given to a child only according to a doctor's prescription. The decision about surgical intervention is made only after the appropriate conclusion of medical specialists. Self-medication is unacceptable for this pathology!

Nutrition

If the oval window is not closed, the child needs adequate nutrition. The diet must include fruits and vegetables with a high potassium content, which strengthens the heart muscle. Legumes, cereals, nuts, dairy products and lean fish and meats are also recommended.

Science does not stand still, and new diagnostic methods make it possible to identify pathologies that were not even known about before. Today, many parents are told that the oval window in children’s hearts is open.

Women need to know that a patent foramen ovale in the baby's heart is normal if they are in their womb, it closes after the baby is born. The fetus needs it to receive the necessary blood circulation and oxygen supply to the still developing organism. What kind of window this is, the reasons for its development, possible complications and treatment methods, you will learn in this article.

Oval window in the heart in children - description

This is the name given to the structural feature of the septum inside the heart, which is present in all children during intrauterine development and is often detected in a newborn. The thing is that the heart of a fetus functions somewhat differently than that of an infant or an adult.

In particular, in the septum separating the atria there is an opening called the oval window. Its presence is due to the fact that the fetal lungs do not work, and therefore little blood enters their vessels.

The volume of blood that in an adult is ejected from the right atrium into the veins of the lungs, in the fetus passes through the hole into the left atrium and is transferred to the more actively working organs of the baby - the brain, kidneys, liver and others. This window is separated from the left ventricle by a small valve that matures completely by the beginning of labor.

When the baby takes his first breath and his lungs open, blood flows into them, which is accompanied by an increase in pressure inside the left atrium. At this moment, the oval window is closed by the valve, and then it gradually fuses with the septum.

If the window closes prematurely, while still in utero, this threatens heart failure and even the death of the child, so the presence of an opening is important for the fetus. Closing the window occurs differently for different children. In some, the valve grows to it immediately after birth, in others - during the first year, in others - by the age of 5.

In some cases, the size of the valve is not sufficient to close the entire oval window, which is why the hole remains slightly open for life, and a small volume of blood is periodically discharged from the pulmonary circle into the systemic circulation.

This situation is observed in 20-30% of children. A foramen ovale that does not close completely after birth is not considered a defect in the septum that divides the atria, since the defect is a much more serious problem. It is considered a congenital defect, and LLC is classified as a minor anomaly, representing only an individual feature.

With a septal defect, the valve is completely absent and blood can be discharged from left to right, which poses a health hazard. There are open foramen ovale and other septal defects. The difference is that such a window always has a valve that regulates blood flow.

If there is a defect, the valve is absent, but there is a hole in the septum, which is visible during ultrasound examination. The oval window is not considered a heart defect; it is classified as a minor anomaly in the development of the cardiovascular system. In infants this is not yet a cause for concern, but in older children the anomaly should not lead to complications.

A serious complication is the so-called “paradoxical embolism” in the case of prolonged non-closure of the window. Emboli are small blood clots, bacteria, even bubbles that leak from venous blood into arterial blood through a window.

If they enter the vessels connecting to the brain, they can cause a bacterial complication or even a stroke. If the child is not at risk for blood clots, a fenestra abnormality may be relatively safe. Window dimensions:

1. If the window size is around 2 - 3 mm, then this is normal, this does not mean any deviations, so there will be no problems.
2. Small window size - up to 5 - 7 mm. Windows of 4.5 - 5 mm are more common. A hole of 7 mm or more is considered large, or “gaping,” and is treated surgically.
3. The maximum size can reach 19 mm. According to research, large windows are much less common among adults.

To understand the meaning of this window, let’s briefly consider what sections the child’s heart consists of. Please note that the human heart consists of four cavities, which are called “heart chambers”. These are two atria: right and left; and two ventricles: right and left.

One of the main functions of the heart is to ensure a constant flow of blood in the body (this function is called pumping). This occurs due to the constant contraction of the heart muscles. When the heart muscle contracts, blood from the chambers of the heart is pushed into the vessels that extend from the ventricles of the heart (arteries), and when it relaxes, the atria are filled with blood that comes from the vessels that flow into the heart (veins).

In adults, the right (atrium and ventricle) and left (atrium and ventricle) sections do not communicate with each other. The atria are divided by the interatrial septum, and the ventricles by the interventricular septum.

Blood circulation in a fetus occurs differently than in an adult. During the prenatal period, the baby has so-called “fetal” (fetal) structures in the cardiovascular system. These include the oval window, the aortic and venous ducts.

All these structures are necessary for one simple reason: the fetus does not breathe air during pregnancy, which means its lungs do not participate in the process of saturating the blood with oxygen. But first things first:

• So, oxygenated blood enters the fetal body through the umbilical veins, one of which flows into the liver, and the other into the inferior vena cava through the so-called ductus venosus.

Simply put, pure arterial blood reaches only the fetal liver, because in the prenatal period it performs an important hematopoietic function (this is why the liver occupies most of the baby’s abdominal cavity).

• The two streams of mixed blood from the upper and lower torso then flow into the right atrium, where, thanks to the functioning foramen ovale, the bulk of the blood flows into the left atrium.

The remaining blood enters the pulmonary artery. But the question arises: why? After all, we already know that the fetal pulmonary circulation does not perform the function of oxygenation (oxygen saturation) of the blood. It is for this reason that there is a third fetal communication between the pulmonary trunk and the aortic arch - the aortic duct. Through it, the remaining blood is discharged from the small circle to the large circle.

Immediately after birth, when the newborn takes his first breath, the pressure in the pulmonary vessels increases. As a result, the main role of the oval window to dump blood into the left half of the heart is leveled out. During the first year of life, as a rule, the valve completely independently fuses with the walls of the hole.

However, this does not mean at all that an unclosed foramen ovale after 1 year of a child’s life is considered a pathology. It has been established that the communication between the atria can close later. There are often cases where this process is completed only by the age of 5 years.

Purpose of an open oval window

The baby's heart develops in utero in such a way that communication between the right and left atrium is simply necessary to ensure the life of the fetus. Therefore, there is an open oval window in the fetal heart. When the baby is born and begins to breathe on its own, saturating the blood with oxygen (O2) in the lungs, the communication of the two atria is not vital and the oval window in the heart begins to gradually close.

The timing of its complete closure varies, but in most children the oval window closes by about one year of age; in some children (not always), the oval window in the heart is allowed to close at a later date.
Thus, a patent foramen ovale is one of the normal stages in which a baby's heart develops.

The human heart normally consists of two parts. Each of them has partitions made of connective tissue. The diagnosis of “patent foramen ovale” means that the hole in the septum between the atria has not completely closed. If the fetus does not have a patent foramen ovale or is not open enough, this can lead to intrauterine death.

Even if it was possible to survive in the womb of the mother, the child dies after birth, less often he develops right ventricular heart failure. Every newborn is born with a patent foramen ovale, which should normally close within one year.

It is very rare that the closing process lasts two or more years. The defect can be diagnosed using ultrasound. The mechanism of development of the anomaly has not yet been thoroughly studied, and its causes have not been fully established. Doctors believe that the factors contributing to the appearance of this defect are:

• the birth of a child before the predetermined date when the baby is premature;
• poor ecological state of the environment;
• hereditary predisposition to diseases of the cardiovascular system;
• exposure to chemicals on the body of a pregnant woman;
• frequent stress and unstable psycho-emotional state of the child’s mother during pregnancy.

It is believed that the highest chances of developing an anomaly are in children whose mothers abused alcohol or drugs during pregnancy and breastfeeding. In a healthy child, the window is closed with a valve. This process happens slowly.

If, as a result of genetic predisposition, the size of the valve is smaller than the size of the window, the latter remains open, but the function of the heart is not impaired. If a child nevertheless develops this anomaly, most likely it will not be possible to get rid of it, but there is no need for this, because an open oval window in the heart in children has almost no effect on their life.

It has been noted that the anomaly is more often observed in premature infants. There is an opinion that the reasons may be smoking and abuse of alcohol or drugs by a woman during pregnancy. Other factors:

• bad ecology;
• heredity;
• chemical exposure;
• stress.

Due to genetic characteristics, the valve that closes the window is slightly smaller in millimeters compared to the hole, which is why it is not able to completely close it. As you can see, some of these reasons depend on the woman herself and her behavior.

If she wants her child to be born and be healthy, she will protect herself from any unfavorable factors. If it was not possible to avoid the anomaly, it is important to remember that it will most likely accompany him throughout his life, but in rare cases it affects work and everyday activities.

With normal development of a newborn, valve closure occurs within the first 3 to 5 hours of life. Overgrowing of a window in children is a longer process, requiring from two months to two years. However, there have been cases where the window did not become overgrown for five years and even throughout life.

So a baby’s window is not yet a reason for concern and immediate treatment. It has been proven that an oval window is present in 35% of people, and in 6% of them, ultrasound revealed a diameter of more than 7 mm. Of these 6%, half are children under six months old.

But what to do if the window has not closed, and by the age of 5-10 years the doctor announces: “the oval window is open”? In a child, the hole may not close tightly due to the structural features of the valve: genetically, it may be smaller than usual.

This happens in premature babies and in those who have been diagnosed with intrauterine developmental pathologies. A defect such as a patent foramen ovale in newborns does not refer to heart defects, but to minor anomalies of cardiac development (abbreviated MARS).

This means that the existing damage does not pose a major threat. People live for years without even suspecting that something is wrong with their hearts.

Another problematic situation is a completely open foramen ovale, when the valve between the atria does not perform its functions at all. This pathology is called atrial septal defect. If a diagnosis has been made, from the age of 3 the child is assigned health group II, and young men of military age are given fitness category “B”, which means limited suitability for military service.

How does the disease manifest itself?

With a small size of the oval window, external manifestations may be absent. Therefore, the attending physician can judge the severity of the nonunion. For infants with an open oval window, it is typical:

1. Blue lips, tip of the nose, fingers when crying, straining, coughing (cyanosis);
2. Paleness of the skin;
3. Increased heart rate in infants.

Adults with pathology may also experience bluish lips with:

1. Physical activity that is fraught with an increase in pressure in the pulmonary vessels (long-term breath holding, swimming, diving);
2. Heavy physical work (weightlifting, acrobatic gymnastics);
3. For lung diseases (bronchial asthma, cystic fibrosis, emphysema, pulmonary atelectasis, pneumonia, with hacking cough);
4. In the presence of other heart defects.

With a pronounced oval hole (more than 7-10 mm), the external manifestations of the disease are as follows:

• Frequent fainting;
• The appearance of bluish skin even with moderate physical activity;
• Weakness;
• Dizziness;
• Child's delay in physical development.

Normally, the size of the oval window in a newborn does not exceed the size of a pinhead and is securely covered with a valve that prevents the discharge of blood from the pulmonary circulation to the large one.

With an open foramen ovale ranging in size from 4.5-19 mm or incomplete closure by the valve, the child may experience transient cerebrovascular accidents, signs of hypoxemia and the development of such severe complications as ischemic stroke, renal infarction, paradoxical embolism and myocardial infarction.

More often, a patent foramen ovale in newborns is asymptomatic or accompanied by mild symptoms. Indirect signs of this anomaly in the structure of the heart, by which parents may suspect its presence, may be:

• the appearance of severe pallor or cyanosis during strong crying, screaming, straining or bathing the child;
• restlessness or lethargy during feeding;
• poor weight gain and poor appetite;
• fatigue with signs of heart failure (shortness of breath, increased heart rate);
• the child’s predisposition to frequent inflammatory diseases of the bronchopulmonary system;
• fainting (in severe cases).

During the examination, while listening to heart sounds, the doctor may register the presence of “murmurs.”

The main diagnostic techniques are:

With their help, you can confirm or refute the diagnosis, determine the size of the open window. These methods do not pose any danger to either the newborn or older children. They allow you to get a detailed picture of the anomaly, after which the doctor decides whether to simply monitor the condition of the heart or prescribe therapy.

When determining a treatment algorithm, the doctor must take into account the following indicators:

• age of the child;
• the health status of the little patient;
• accompanying illnesses;
• are there any allergies to drugs;
• are there any contraindications?

Only an experienced doctor who has previously encountered similar cases in his practice can accurately diagnose. Since the disease does not manifest itself specifically, it can be detected by studying other pathological disorders.

The following signs should prompt you to consider referring a doctor to a cardiologist:

1. With exertion, cyanosis of the skin in the lip area appears.
2. Up to 10 years of age, a child may be behind in development, both physically and mentally.
3. Children aged 13 to 15 years are less resilient than their peers.
4. Due to poor blood flow and insufficient supply to the respiratory system, the child develops diseases such as pneumonia and bronchitis.

If the defect is found in a newborn child, no therapy is carried out and no intervention is required.
Echocardiography is the “gold” standard and the most informative method for diagnosing this pathology. The following signs are usually detected:

1. Unlike ASD, when the foramen ovale is open, it is not the absence of part of the septum that is revealed, but only its wedge-shaped thinning is visible.
2. Thanks to color Doppler ultrasound, you can see “swirls” of blood flow in the oval window area, as well as a slight discharge of blood from the right atrium to the left.
3. With a small size of the foramen ovale, there are no signs of enlargement of the atrium wall, as is typical for ASD.

The most informative is an ultrasound examination of the heart, performed not through the chest, but the so-called transesophageal echocardiography. In this study, an ultrasound probe is inserted into the esophagus, as a result of which all the structures of the heart are visible much better.

This is explained by the anatomical proximity of the esophagus and the heart muscle. The use of this method is especially relevant for obese patients, when visualization of anatomical structures is difficult.

In addition to cardiac ultrasound, other diagnostic methods can be used:

• An electrocardiogram may show signs of bundle branch block, as well as conduction disturbances in the atria.
• With a large foramen ovale, changes in the chest x-ray are possible (slight enlargement of the atria).

Most often, MARS syndrome does not cause any complaints or complications. In these cases, no treatment is required. Some specific loads pose a risk of complications. In children who are many years old, blood can be shed during diving, paroxysmal coughing, or exercise, which is accompanied by holding their breath or straining.

Such children should not be exposed to scuba diving, weightlifting, or deep-sea diving year after year. Therefore, parents should not worry if their child has a PFO, but there are no other heart disorders, chronic diseases, or interference with blood circulation, no matter how old he is, everything is going well and the prognosis is favorable.

A patent foramen ovale in newborns is not a cause for concern! But for this to really be the case, doctors advise avoiding serious physical activity and monitoring your health and doctors. If the risk of blood clots is high, doctors prescribe anticoagulants.

If the size of the hole is large and blood is discharged from one atrium to another, surgery may be prescribed. It is based on inserting a catheter into the artery. At its end there is a special device that completely covers the oval window.

Depending on how old the child is, the doctor decides to perform such an operation or not. Antibiotics must be taken for six months after surgery to prevent the development of bacterial endocarditis. So, if the baby is only a year old and has OOO, you should wait, this condition may disappear.

If it persists, there is no need to worry either; today there are modern methods of treating this anomaly. There is every chance that the child’s health will not suffer! Treatment of PFO is not always required: in children under the age of 4 - 5 years, the window can close on its own.

At an older age, you should also not panic; medical supervision, ECG and EchoCG are necessary. Cardiologists recommend being examined every six months.

• If the doctor detects a risk of blood clots, treatment under his supervision and the use of special blood thinning medications are recommended. Also in such cases, doctors advise avoiding excessive stress.
• If the hole is larger than normal, surgical treatment may be required. It consists of inserting a tube with a special “closer” at the end, which completely removes the lumen between the atria.

According to experts, you need to monitor the child’s daily routine, nutrition, and not overload him (including psycho-emotionally). You should stick to protein foods in your diet, eat vegetables and fruits. You should also not run any infections, even the most seemingly insignificant ones. Any malfunction in the body can potentially affect the functioning of the heart.

An open oval window poses a danger to the life and health of a child if he is diagnosed with the following concomitant diseases:

• pulmonary hypertension;
• pathologies of the respiratory system;
• thromboembolism.

Thromboembolism poses a particular danger to the health and life of a child, so it is necessary to take all measures to prevent its occurrence.

When blood clots enter the pulmonary artery, they spread to all internal organs:

1. Blood clots entering the brain vessels can cause a stroke.
2. If clots accumulate in the coronary vessels, myocardial infarction occurs.
3. When the arteries of the limbs become blocked, ischemia occurs and they can die.

Blood clotting increases, and at the same time the risk of blood clots increases if the patient has undergone massive surgical interventions, has been in an inactive state for a long time, and the following disorders have been diagnosed:

• atrial fibrillation;
• aneurysms of blood vessels and heart.

If these factors are present, the patient is prescribed blood thinning medications (anticoagulants). The dose and regimen are determined in each case individually.

Drug therapy can be indicated only for children with signs of heart failure, transient ischemic attack (nervous tics, asymmetry of facial muscles, tremors, convulsions, fainting) and, if necessary, the prevention of paradoxical embolism.

They may be prescribed vitamin-mineral complexes and drugs for additional nutrition of the myocardium:

• Panangin,
• Magne B6,
• Elkar,
• Ubiquinone,
• antiplatelet agents (Warfarin).

The need to eliminate a patent window in newborns is determined by the volume of blood discharged into the left atrium and its effect on hemodynamics. In case of minor circulatory disorders and the absence of concomitant congenital heart defects, surgical treatment is not required.

There are cases when a surgical solution to the defect is indicated, but there must be good reasons for this. Surgery is prescribed in the following cases:

• the diameter of the open window is more than 9 mm;
• more blood is released than normal;
• complications from the respiratory or cardiovascular systems appear;
• the patient has limited activity;
• There are contraindications to taking medications.

Surgery may be required if the oval window has a large diameter with blood flowing into the left atrium.
Currently, endovascular surgery has become widespread. The essence of the intervention is that a thin catheter is installed through the femoral vein, which is passed through the vascular network to the right atrium.

The movement of the catheter is monitored using an X-ray machine, as well as an ultrasound sensor installed through the esophagus. When the area of ​​the oval window is reached, so-called occluders (or grafts) are inserted through the catheter, which are a “patch” that covers the gaping hole.

The only drawback of the method is that occluders can cause a local inflammatory reaction in the heart tissue. In this regard, the BioStar absorbable patch has recently been used. It is passed through a catheter and opens like an “umbrella” in the atrium cavity. A special feature of the patch is its ability to cause tissue regeneration.

After attaching this patch to the area of ​​the hole in the septum, it dissolves within 30 days, and the oval window is replaced by the body's own tissues. This technique is highly effective and has already become widespread.

All manipulations are performed using the endovascular method (also called transcatheter closure). A catheter is installed on the right thigh, through which an occluder - an umbrella-like device on both sides - is delivered to the heart through the vessels using special instruments. Once the occluder is opened, the hole is securely plugged and the problem disappears.

The advantage of such interventions is obvious: there is no need to cut the chest, stop the heart, resort to artificial circulation, or use deep anesthesia. For a child who has undergone surgery in the first 6 months, antibiotic therapy is prescribed to prevent bacterial endocarditis.

So, an open oval window found in newborns is not a cause for alarm at all. If the window has not closed after 2-5 years, it is necessary to observe and consult a cardiologist. Discussions about what is “normal” and what is “pathology” are still ongoing.

Therefore, each case will be individual. However, most situations are not life-threatening and do not require treatment.

Many parents worry that the “hole in the heart,” as they call it, will endanger the child’s life. In fact, this problem is not dangerous for the baby and most children with an open window feel quite healthy.

It is only important to remember some restrictions, for example, in relation to extreme sports or professions in which the load on the body increases. It is also important to have your baby examined by a cardiologist every 6 months with an ultrasound examination.

If the foramen ovale remains open after the child's fifth birthday, it is most likely that it will not heal and will be with the child for the rest of his life. Moreover, such an anomaly has almost no effect on work activity. It will become an obstacle only to obtaining the profession of a diver, pilot or astronaut, as well as to strong sports loads, for example, weightlifting or wrestling.

At school, the child will be classified in the second health group, and when conscripted, a boy with LLC will be counted in category B (there are restrictions during military service). It is noted that at the age of over 40-50 years, the presence of PFO contributes to the development of coronary and hypertension.

In addition, during a heart attack, an unclosed window in the septum between the atria has a negative impact on the recovery period. Also, adults with an open window experience migraines more often and often experience shortness of breath after getting out of bed, which immediately disappears as soon as the person goes back to bed.

Among the rare complications of PFO in childhood, embolism may occur. This is the name for the entry into the bloodstream of gas bubbles, particles of adipose tissue or blood clots, for example, during injuries, fractures or thrombophlebitis.

When emboli enter the left atrium, they travel to vessels in the brain and cause brain damage, sometimes fatal. It happens that the presence of a patent foramen ovale helps improve health.

This is observed in primary pulmonary hypertension, in which shortness of breath, weakness, chronic cough, dizziness, and fainting occur due to high pressure in the vessels of the lungs. Through the oval window, blood from the small circle partially passes into the large circle and the vessels of the lungs are unloaded.

Parents whose children have been diagnosed with a patent foramen ovale should follow these recommendations:

• Even in the absence of pronounced symptoms, it is necessary to register the child with a cardiologist. The doctor should monitor the child regularly.
• An open foramen ovale in the heart and sports accompanied by heavy loads are incompatible. Physical exercises should not contain strength exercises or excessive tension of the abdominal muscles.
• The child should be protected from running, squats, jumping and anything that could provoke a shunt. The daily routine should be properly organized to balance the child’s periods of activity and rest. You need to include naps in your schedule.
• Every 2 hours you need to do a little exercise and stretch your leg muscles to prevent the possibility of developing vein diseases in the future. Pay attention to the positions in which the child sits. Teach him to sit with the correct position of his legs: they should not be tucked in or folded crosswise.
• The best way to prevent future stroke is to lead an active lifestyle to prevent blood stagnation in the lower extremities and prevent venous disease.
• Experts recommend hardening and restorative procedures.
• Children with this diagnosis need an annual holiday at a resort and regular walks in the fresh air.
• Make sure your child has enough fluids to drink every day.

Do not let your child notice your concerns about his health - this can lead to panic and increased nervousness. This will not help improve his condition. Always be calm, good-natured and attentive to your child.

Take care of his mental comfort. And over time, transformations in the oval window of his heart will lead to its overgrowth. The main thing is to follow the recommendations of specialists.

There are no special methods for preventing an open oval window. To prevent a person from developing a patent oval window, his pregnant mother needs to lead a healthy lifestyle:

• quit smoking and alcohol;
• eat rationally and balancedly (limit consumption of fried, spicy, smoked foods, eat more foods high in fiber (vegetables, fruits, herbs).

Prevention of heart defects in the fetus (disorders of heart structures) includes several principles. A woman needs:

• avoid contact with ionizing radiation (from X-ray machines, thermonuclear reactions);
• with various chemicals (vapors of varnishes, paints, some medications);
• avoid the occurrence of infectious diseases (a disease such as rubella is especially dangerous, which in most cases leads to congenital heart disease, deafness and cataracts (damage to the lens of the eye)