Reasons for the development of an aneurysm of the MPP
An aneurysm forms in a place where the oval window functioned during the intrauterine period of life. This is the hole through which the blood moved immediately into the left atrium, starting a large circle. There was no need to pump it into the lungs, since the respiratory organs did not work. After birth, the first breath of the newborn and the intersection of the umbilical cord, the small circle of blood circulation begins to work. The opening between the atria closes almost immediately, but sometimes this process can take up to a year, which is not considered a pathology.
If the connective tissue, which, together with muscle fibers, tightens the oval window, is not strong enough, under pressure it begins to stretch and prolapse in one direction or another.
The reliable reasons for the intrauterine development of the MPP aneurysm have not yet been established, but it is believed that infections suffered by the mother during pregnancy, stress, the use of certain drugs, smoking and alcohol consumption can significantly affect the formation of the cardiovascular system of the unborn child. Factors such as unfavorable environmental conditions, a lack of trace elements and vitamins in the diet of a pregnant woman, as well as genetic disorders that can lead to connective tissue dysfunction are taken into account.
Often with hereditary dysplasia, not only the heart suffers, but also the joints, bones and even the lens of the eye. With such pathologies, the structure or properties of the connective tissue change. The atrial septum becomes flaccid, does not resist pressure within the chambers of the heart, and stretches.
The same mechanism occurs when scarring the area of the myocardium in which the infarction occurred. Despite the fact that MI more often affects the interventricular septum, aneurysm in adults affects the prognosis of survival and can be complicated by ruptures and thromboembolism of the cerebral vessels, which, in turn, is a direct cause of ischemic stroke.
There are three types of MPP aneurysms:
- With a bend in the right atrium.
- With a deflection in the left atrium.
- S-shaped aneurysm.
The direction of the deflection does not matter, since the symptoms are the same, but when combined with other heart defects and the occurrence of hemodynamic disorders, the manifestations become more pronounced.
If the prolapse of the interatrial septum occupies a large area or reaches pathological values, this can lead to the organization of blood clots due to turbulent flow in the aneurysm, cardiac arrhythmias due to additional stimulation of the conducting system, circulatory dysfunction due to the absence of normal atrial emptying during contraction. Severe protrusion can prevent the valves from working. If at the same time there is a shunting (discharge) of blood from left to right in connection with an open oval window or a ruptured aneurysm, pulmonary hypertension develops due to overload of the small circle.
Symptoms and manifestations
In newborns and children of preschool and young age, atrial septal aneurysm most often does not manifest itself in any way. However, due to growth spurts in adolescence, during physical and stressful exertion and during pregnancy, it can manifest with symptoms that vary in degree of manifestation in each individual case:
- Heart rhythm disturbances;
- Reduced resistance to loads;
- Interruptions in the work of the heart;
- Chest pain;
- Dizziness;
- Nausea;
- Cyanosis of the tip of the nose and nasolabial triangle during exercise and when breastfeeding a newborn;
- Headache;
- Tachycardia;
- Anxiety;
- Sleep disturbances;
- Psychological discomfort in children and adolescents.
In combination with other heart defects, more serious manifestations come to the fore:
Frequent upper respiratory tract infections;
- Chronic bronchitis;
- Dyspnea;
- Swelling.
In patients who have survived acute myocardial infarction, who have formed an atrial septal aneurysm in adults measuring more than 10 mm according to ultrasound, there is some risk of rupture. The mortality rate is high, but this condition occurs very rarely.
Clinical manifestations unfold sharply and at a high rate:
- Pallor, turning into cyanosis of the skin of the face and palms;
- Loss of consciousness;
- Noisy breathing;
- Cold clammy sweat;
- Dyspnea.
Diagnostic and treatment methods
The main method for diagnosing an atrial septal aneurysm is ultrasound of the heart with Doppler ultrasound. It is prescribed for children who have noise during auscultation, as well as for patients who have had acute myocardial infarction. The presence of MPP prolapse more than 1 cm is considered to be an aneurysm.
If ultrasound does not give a complete picture of the anatomy of the heart, additional studies are prescribed, such as computed tomography of the chest, transesophageal ultrasound, or catheterization with contrast.
Children who are diagnosed with MPP aneurysm and have no symptoms are not prescribed treatment, but annual checkups by a pediatric cardiologist are required. It is not recommended to restrict the child in active games, but in order to decide on the possibility of playing sports, you need to consult a doctor.
Women with an MPP aneurysm who are planning a family, or pregnant women with a newly diagnosed defect need a cardiologist's consultation with an ultrasound scan. In most cases, with such a pathology, pregnancy and physiological childbirth are not contraindicated.
If a patient with an aneurysm of the MPP has a concomitant pathology, or clinical signs require correction, drug therapy is prescribed:
- Membrane stabilizing and antioxidant drugs;
- Anticoagulants and antiplatelet agents;
- Preparations and vitamin supplements containing magnesium and potassium;
- Antiarrhythmics.
Surgical interventions are rare. However, such treatment measures are necessary in case of rupture of an aneurysm or non-overgrowth of the oval window, accompanied by hemodynamic disorders. At the moment, the defect is sutured, plastic is performed, as well as minimally invasive manipulations - the introduction of an occluder using a catheter.
Conclusions
There are no specific prophylaxis measures to prevent MSA aneurysm. Pathology monitoring includes regular examinations by a cardiologist with an ultrasound examination of the heart. This rule works for all categories of patients - for children, pregnant women, as well as those who have had myocardial infarction.
An anomaly in the structure of the heart in the absence of concomitant pathology does not affect either the quality of life or its duration.
