Oval window in the heart in children characteristic, causes of pathology, symptoms and treatment

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Oval window in the heart in children

A physiological function appears in the embryo throughout fetal advancement. The 2 atria are linked by an opening through which blood passes. The fetal lungs are compressed and do not work; they do not need oxygenation through the blood.

Such a gadget of the heart speeds up the blood flow cycle and saturation of the organs that require it (mostly the brain and spine). When the infant is born, takes the very first breath, its lungs open, start to work completely.

There is a requirement for adequate blood circulation to them. The hole in the heart ends up being unneeded. It starts to close after the very first breath due to increased pressure in the left atrium.

Nature supplies a valve that shuts and blocks the circulation of blood. Ideally, the window closes throughout the initially 5 hours of life, and entirely vanishes by the 1st year. An open window in the heart of a kid of 2 years is likewise thought about the standard.

Closing the valve, it slowly overgrows with connective and muscle tissue. In some cases, when taking a look at a kid, medical professionals discover an open hole. If this happens over the age of 2 years, then a little irregularity of the heart is detected.

It sounds a little frightening, however in truth its extremely existence does not present a danger to life and health. Approximately 20% of grownups have this function.

An open oval window in the heart of a kid is not a vice. This is a minor variance from the standard of the physiological structure. If the physician, according to the outcomes of ultrasound, identifies an open window in a kid at the age of 5, then more than likely it will stay for life.

The window is from 3 mm to 2 cm in size, depending upon the size of the heart, the age of the client. More frequently it does not surpass 5 mm. The truth of the existence of an oval window does not damage health. Under particular conditions, it can end up being the origin of illness of the lungs and circulatory system.

This occurs when the kid’s heart grows, however the oval window valve doesn’t. As an outcome, it stops to represent the essential measurements in order to entirely cover the hole. Blood moves from the 1st atrium to another, the load on the heart boosts.

In mix with some illness (persistent illness of the lungs, veins, other heart pathologies), the pressure of the best atrium boosts. The exact same thing occurs throughout pregnancy, giving birth. In such scenarios, you need to constantly be under the guidance of a medical professional to avoid a decompensated state.

There are times when the anomaly needs surgical intervention. A non-overgrowing window can relieve the condition of the client (it occurs in clients with lung high blood pressure, in which the pressure in the vessels is considerably increased). In the case of an open window, part of the blood goes into instantly into the left atrium, bypassing the lungs. As an outcome, the vessels are unloaded, the pressure drops.

What is an open oval window for?

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The heart of the fetus, which is in the womb, is frequently contracted, supplies blood flow in all organs other than the lungs. Blood enriched with oxygen goes into the fetus from the placenta through the umbilical cable. The lungs do not work, and the underdeveloped vascular system in them does not represent the formed heart.

Blood blood circulation in the fetus bypasses the lungs. For this, an oval window is planned, which releases blood from the cavity of the best atrium into the cavity of the left, which makes sure blood circulation without entering the lung arteries. Its function is that the hole in the septum in between the atria is covered by a valve from the left atrium.

The oval window can offer only one-way interaction in between them – just the right and left.

Intrauterine blood circulation in the fetus happens according to the plan:

  1. Blood filled with oxygen streams through the umbilical vessels into the venous system of the fetus.
  2. Through the venous vessels, blood goes into the cavity of the best atrium, which has 2 exits: through the tricuspid valve into the best ventricle and through the oval window (opening in the septum in between the atria) into the left atrium. The vessels of the lungs are closed.
  3. An boost in pressure throughout contraction presses the valve of the oval window, and part of the blood is released into the left atrium.
  4. From it, blood goes into the left ventricle, which guarantees its motion into the aorta and all arteries.
  5. Through the veins linked to the umbilical cable, blood goes into the placenta, where it blends with the mom.

The oval window is an essential structure that supplies blood flow to the fetus in the prenatal duration. But after the birth of a kid, it needs to not work and slowly overgrows.

Causes of pathology

The factors for the existence of an open oval window of 2 mm or bigger in the heart are various, they are impacted by the physiological attributes of the body of each specific person.

At the minute, there are no tested clinical theories or presumptions that might completely corroborate and validate the particular causes of the pathology. When the valve does not grow together with the edges of the oval window, different aspects end up being the cause.

The taken echocardiography or ultrasound of the heart can discover the existence of LLC.

The inadequate closing of the open window is because of a number of factors:

  • bad genetics;
  • prematurity of the newborn;
  • genetic pathologies of the heart;
  • connective tissue dysplasia;
  • unfavorable ecological aspects;
  • bad nutrition of a pregnant lady;
  • Passion for alcohol and cigarette smoking by expectant mom.

If the fetus does not have such a window or when it is too soon closed, it establishes:

  • best ventricular failure;
  • fetal death of the embryo;
  • death of a newborn instantly after birth.

All children are born with an open oval window. It slowly closes and after a specific time vanishes entirely. When babies or children start to sob, yell, fret, the oval window briefly reveals its function.

This is revealed as an ejection of venous blood through the space in the heart and the look of a nasolabial triangle. The valve slowly overlaps the edges of the opening and the oval window vanishes. Sometimes the valve is unable to close the recess entirely due to too little sizes, which provokes the non-closure of the natural oval window.

Underdevelopment of the valve provokes bad ecology and demanding conditions, cigarette smoking or drinking alcohol by the mom throughout pregnancy, or consistent contact with harmful parts.

An open oval window in the heart of a grownup stays if problems, sluggish development or prematurity are discovered in youth. In the existence of thrombophlebitis of the legs or the pelvic zone, some individuals experience a pressure boost in the zone of the right heart areas, which consequently causes the look of an open little oval window in grownups.

Hereditary causes, dysplasia of connective tissue, flaws of the heart or valves of a hereditary nature can result in the opening of windows in older children in the advancement procedure.

If a kid is included in sports, he is at threat of such a flaw, given that playing sports seriously impacts his health. Since the physical load in gymnastics, sports or other sports activities is major, this provokes the look of a window.

Symptoms

In most cases, the pathology of the LLC profits without the symptom of any symptoms. It is possible that the indications appear rather weakly.

If we speak about the symptoms of pathology in children, they identify:

  • cyanosis of the surface area of the skin;
  • pallor of the location around the lips, observed throughout a little load of the body;
  • regular colds;
  • illness of the bronchi, lungs;
  • sluggish weight gain.

If we speak about older children, indications might appear:

  • tiredness throughout heavy physical effort;
  • dyspnea;
  • regular pulse.

Experts think that if the oval window is not overgrown prior to 5 years, more than likely this will not occur. The kid will need to cope with heart illness for the rest of his life.

With a noticable oval hole (more than 7-10 mm), the external symptoms of the illness:

  • Frequent passing out;
  • The look of blueness of the skin even with moderate physical effort;
  • Weakness;
  • Dizziness;
  • Lag of the kid in physical advancement.

Normally, the size of the oval window in the newborn does not surpass the size of the pin head and is dependably covered by a valve, which avoids the discharge of blood from the lung blood circulation to the big.

With an open oval window from 4,5-19 mm in size or insufficient closing with a valve, a kid might experience short-term disruptions in cerebral blood circulation, indications of hypoxemia and the advancement of serious issues (ischemic stroke, kidney infarction, paradoxical embolism and myocardial infarction).

More frequently, an open oval window in babies is asymptomatic or is accompanied by moderate symptoms.

Indirect indications of an irregularity in the structure of the heart, according to which moms and dads might presume its existence, might be:

  • the look of sharp pallor, cyanosis throughout serious sobbing, yelling, straining, bathing a kid;
  • stress and anxiety, sleepiness throughout feeding;
  • bad weight gain, bad hunger;
  • tiredness with indications of heart failure (shortness of breath, increased heart rate);
  • the kid’s predisposition to regular inflammatory illness of the bronchopulmonary system;
  • fainting (in serious cases).

When taking a look at while listening to heart sounds, the physician can tape-record the existence of “noise”. At a young age, the anomaly might not trigger definitely any hassle.

But after 45-50 years, there is a high possibility that the existence of an open oval window can intensify an individual’s existing heart diseases.

Diagnostics

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By a regular evaluation, it is impractical to expose a hole in the heart septum. Parents might, for the function of avoidance, analyze the kid or presume an irregularity in blue skin (scattered cyanosis) while still in the health center.

A comparable indication does not constantly happen and is frequently a repercussion of other pathological procedures. For a precise medical diagnosis, you will require to go through an assessment:

  • Ultrasound (ultrasound) of the heart muscle (echocardiography), is performed together with dopplerography. The essence of this diagnostic technique is to figure out the instructions of motion, the quantity of blood pressed into the hole on the septum and the recognition of other abnormalities. The outcomes will assist the physician understand the seriousness, course of the pathological procedure.
  • Echocardiography of a contrast type is utilized to successfully discover flaws and holes in the septum.

The client will be provided an injection of saline, which was shaken in advance. If there is a window in the heart, the blisters will permeate into it, passing from 1 atrium to another.

Transesophageal echocardiography is utilized very seldom as an ultrasound scan of the heart.

Despite the discomfort of the treatment, it has the ability to figure out the precise area and size of the window in the septum, to see the existence of issues (myocarditis, embolism, aneurysms, and others).

  • Chest x-ray is utilized to figure out the size of the heart, the density of its vessels, and the recognition of stagnant procedures. In the existence of abnormalities of the septum, the volume of the organ is increased, and blood tension is observed in the lungs.
  • Electrocardiography (ECG) enables you to find out about offenses in the work and structure of the heart, which are characteristic of a window in the septum, for instance, arrhythmia or hypertrophy of the left ventricle. An anomaly by such a hardware technique cannot be discovered.
  • As issues brought on by a hole in the septum establish, other diagnostic techniques might be needed. The most pertinent heart catheterization, magnetic resonance imaging, calculated tomography and ultrasound evaluation of the kidneys.

    Terms of treatment of pathology

    If an abnormality is discovered in the kid, there is no requirement to panic. First of all, take note of the size of the hole. If it does not surpass 3 mm, there is no factor for issue. The window will definitely overgrow in the future. For control, you require to go through a 2nd ultrasound in a couple of months.

    When you open the window 3-7 mm., Treatment, as a guideline, is not recommended. Only a routine ultrasound evaluation is essential, the frequency of which will be identified by the physician. If it ends up that the opening is lowered by ultrasound, the most ideal option in the circumstance is just to wait.

    The oval window in the heart of children tends to overgrow spontaneously. There is a high possibility that a person of the subsequent assessments will reveal total closure of the flaw.

    If the window size surpasses 7 mm. – major steps will be needed. In addition to consistent tracking of the kid by a pediatrician and cardiologist, surgical treatment might be needed. This is unusual when the pathological result of the flaw resembles heart illness.

    The biggest threat is the threat of paradoxical embolism (thromboembolism), when a venous thrombus goes into the artery through an open window in between the atria and distributes in a big circle of blood flow. This can impact the working of the brain, lungs, and in the rarest cases, can result in death.

    Therefore, an open oval window in babies is thought about an alternative of the standard. Do not fret, as it, in the large bulk of cases, closes, entirely overgrows by an optimum of 5 years.

    Most frequently, the flaw does not bring any pain, does not manifest itself with symptoms. If the kid does not have any concomitant illness (heart flaws, circulatory conditions, embolism), then the diagnosis for effective flaw overgrowth is most beneficial.

    When a grownup has symptoms of an open window, they disrupt active motion, workout, or there are other concomitant illness that, integrated with an abnormality, have a pathological result on the body. Doctors recommend moms and dads to guarantee that the kid does not experience overload.

    You ought to cancel sports, weight lifting, swimming, diving to depth. If embolism are most likely to happen, they are recommended to occasionally perform courses of treatment with blood thinning anticoagulants (Warfarin, Aspirin, Clopidogrel).

    In cases of a danger to the life and health of the kid, a surgery is carried out. Assign at a high level of threat of establishing paradoxical embolism, with a noticable ejection of blood from the right to the left atrium. The significance of the operation is that a catheter is placed into the capillary, with the aid of which the oval window is closed.

    In Europe, established an efficient method. Like an occluder, a spot is put on the oval window that promotes the development of connective tissue, that is, the recovery of the oval window happens naturally within 1 month.

    Having satisfied its function, the spot deals with. The physician’s choice on the consultation of the operation depends upon the age of the kid and associated illness.

    Treatment

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    An open oval window in the heart can close even at 5 years of ages, and this is thought about an alternative of the standard. Therefore, no treatment is essential. It is essential to frequently speak with a cardiologist, do ultrasound tracking of the heart to keep track of the condition of the open oval window.

    Older children ought to restrict particular types of exercise, which can increase pressure in the best atrium. These are workouts accompanied by holding your breath and straining. Medical treatment for LLC is not performed. The just exception is when coagulation is increased.

    In this case, it is essential to take anticoagulants to avoid the event of embolism. Under the condition of a “gaping” oval window or with a big hole size, surgical treatment might be essential.

    Parents in no case needs to restrict the motor activity of the kid. The heart requires to be trained. First of all, you require to arrange the right day-to-day regimen. For children with LLC it is necessary to invest a lot of time outdoors. They can actively play, run, leap, engage in practically any sports.

    Nutrition ought to be well balanced, total. Particular attention needs to be paid to an enough quantity of protein in the kid’s diet plan (meat, fish, home cheese, eggs). In the day-to-day menu needs to exist fresh fruits and veggies.

    It is essential to get rid of the persistent foci of infection: caries, pharyngitis, etc. Take determines to solidify the body and boost resistance. Even a breathing viral infection needs to not be permitted to wander, as it can result in issues.

    Medication

    Drug treatment is shown for children with indications of heart failure, short-term ischemic attack (anxious tic, asymmetry of facial muscles, tremblings, cramps, passing out) and, if essential, avoidance of paradoxical embolism.

    When grievances happen, medication is recommended in the type of cardiotrophic drugs and nootropics:

    These drugs enhance myocardial nutrition, enhance workout tolerance. Recently, it has actually ended up being reputable that the drug levocarnitine (Elkar) adds to the fast closure of the oval window if you consume it for 2 months at a rate of 3 times a year. True, it is unclear what this is gotten in touch with.

    It occurs that the oval window can result in circulatory conditions, heart failure. In pediatric practice, this is unusual, in most cases happens by 30-40 years.

    Then the concern of surgical intervention with the closure of this hole is chosen. In the treatment of an open oval window utilizing:

    Drugs are utilized to avoid possible thrombotic or thromboembolic issues. When utilizing them, the so-called systemic anticoagulant treatment occurs, it is generally shown for clients with an open oval window and a history of short-term ischemic attack or stroke, and it is this classification of clients that has a high threat of establishing paradoxical embolism.

    The most typical anticoagulant is Warfarin (Coumadin). The concept of action is that it obstructs the production of vitamin K in the liver, which is actively included in the procedure of hemostasis.

    It is necessary to keep in mind that the usage of warfarin needs continuous lab tracking. The most typical technique for managing anticoagulant tyranny is the worldwide stabilized ratio or INR.

    To avoid apoplexy with an open oval window, the indication needs to be preserved in the variety of 2-3.

    Disaggregants or antiplatelet drugs.

    A normal agent of the group of drugs is Aspirin. Used in a dosage of 3-5 mg/kg daily. The point of drug direct exposure to aspirin is a platelet cell, which after interaction with aspirin ends up being non-active for 10 days for aggregation, that is, the gluing procedure throughout the development of a thrombus.

    The consistent usage of low dosages of aspirin has actually shown to be extremely reliable in the avoidance of venous deficiency, venous apoplexy and ischemic stroke.

    Operative intervention

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    Indications for surgical intervention in children with a verified medical diagnosis of LLC:

    • substantial pathological discharge of blood;
    • flaw size surpasses 9 millimeters;
    • the existence of issues;
    • constraint of client activity;
    • rejection to continuously take medication.

    At this time, surgical treatment is performed solely in the endovascular technique. An unique catheter is placed through the artery on the best thigh, an occluder lies at the end – an device in the form of an umbrella, which opens in the right place and reliably clogs the hole, thereby eliminating the pathology.

    The advantage of the operation is that there is no need to open the chest, stop the heart and apply deep anesthesia. After surgery, antibiotics are needed to prevent bacterial endocarditis.

    Additional grounds when surgery is required in any case:

    • septal defect;
    • heart defects;
    • large hole size;
    • missing valve.

    Due to the seriousness of the complications, each case of an unclosed open window should be considered individually by a good cardiologist, preferably several, in order to determine whether an operation is necessary in a particular case.

    Manipulations are performed by the endovascular method (also called transcatheter closure). A catheter is placed on the right thigh, through which the occluder is delivered to the heart through the vessels with special tools – a gadget like an umbrella on both sides.

    After the occluder opens, the hole is securely plugged and the problem disappears. The introduction of the occluder into the cavity of the heart blocks the communication of blood between the atria, as if “patching” the hole.

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

    Therapeutic diet

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    Diet with an open oval window Patients with an open oval window must follow a diet. Smoked products should be excluded from the diet, add less salt to dishes, do not drink alcoholic beverages. The menu recommends adding fresh vegetables and fruits, which include fiber.

    Potatoes need to be cooked in a peel to preserve the potassium that it contains. It is good for the heart muscle. In addition to potatoes, this element is found in pumpkin, raisins, cabbage. It is useful to drink a decoction of rose hips, strong coffee and tea should be replaced with freshly squeezed juice, compote and medicinal decoctions.

    The diet should also include foods that include magnesium. These include carrots, beets, walnuts, black currants, etc. Animal fats experts recommend replacing with vegetable oil. Dishes should preferably be steamed or in the oven.

    It is better to replace meat and mushroom soups with vegetarian broths. It is recommended to substitute flour products and sweets with honey, dried fruits and nuts. It is useful to spend an unloading day once a week. You need to eat low-fat cottage cheese, various fruits, drink juices.

    Legumes, fried meat and fish, sausages, canned and pickled products, spices and spices should be excluded from the diet. You should forget about vegetables such as onions, garlic and radishes.

    The following is a sample menu for 5 meals:

    • Breakfast – pumpkin porridge, wholemeal bread, a glass of kefir, 1 apple, 1 orange.
    • Lunch – 1 banana, 1 apple.
    • Lunch – pea soup, a slice of boiled low-fat fish, a slice of bread from second-grade flour, dried fruit compote.
    • Snack – fat-free cottage cheese, kefir.
    • Dinner – boiled potatoes with boiled chicken breast, second-grade bread, compote of their dried fruits, 1 orange.

    Danger anomalies

    Rare complications of this pathology may also include embolism. Emboli are small particles of adipose tissue, blood clots, or gas bubbles. In the normal state, they are absent in the bloodstream, but with chest injuries, fractures, or other problems, they can enter the bloodstream.

    If there is an LLC, then they can enter the blood vessels of the brain through the left atrium through the veins and, clogging them, lead to the development of strokes and heart attacks of the brain. Although this is a rather rare problem, nevertheless, if a long course of treatment is necessary in case of injuries or planned operations, it is necessary to warn the attending physician about this feature of the body.

    In a calm state, an oval window in the cardiac septum does not appear. Disruptions in blood supply occur mainly when coughing and getting physical exertion.

    Particular attention should be paid to the health of the child in the event of the following dangerous factors:

    • Sometimes the valve that closes the hole in the septum lags behind the growth of the heart muscle. The window ceases to be obscured, and blood flows from one atrium to another. A large load falls on them, which leads to various complications.
    • Pathological processes leading to an increase in pressure in the best atrium can open the hole. Often the cause is a disease of the respiratory system, cardiovascular system and veins, as well as the period of pregnancy and childbirth.

    Such problems require urgent intervention. Parents should take the child to the doctor to prevent the anomaly from transitioning from the compensation phase to decompensation. For the latter type of course, the occurrence of various complications is characteristic.

    A complete list of them can be seen below:

    • stroke;
    • malfunctions in the cerebral circulation;
    • myocardial infarction;
    • necrosis of the kidney area caused by ischemia (lack of nutrition).

    Failures are mainly triggered by embolism, that is, blockage of a vessel by a detached blood clot. It rarely develops, but because of the seriousness of the possible consequences, the patient is recommended to be observed by a doctor and periodically undergo examination.

    According to statistics, in people older than 45 years, an oval window in the septum provokes the development of hypertension and coronary heart disease. It is no less dangerous after an experienced myocardial infarction, when the recovery period began.

    An open hole slows it down significantly. This anomaly also often provokes migraine attacks and shortness of breath after rising from the bed, which disappears if the patient lies back.

    This anomaly has small advantages due to which the quality of life will improve in certain situations, for example, with pulmonary hypertension. A person due to the manifested pressure experiences constant shortness of breath, cough, general weakness and periodically loses consciousness.

    An oval window in the septum promotes the withdrawal of part of the blood from the pulmonary arteries. The severity of the pathology decreases and the patient’s condition improves.

    Recommendations to parents and prognosis

    Parents whose children were diagnosed with an open oval window should follow these recommendations:

    • Even in the absence of pronounced symptoms, it is necessary to put the child on the register with a cardiologist. The doctor should observe the baby regularly.
    • An open oval window in the heart and sports, accompanied by heavy loads, are incompatible. Exercise should not contain strength exercises and excessive tension of the abdominal muscles.
    • You should protect the child from running, squats, jumping and everything that can provoke a shunt. The regimen of the day should be properly organized to balance the periods of activity and rest of the child. It is necessary to include daytime sleep in the schedule.
    • Every 2 hours you requirement to do a little exercise, stretch your leg muscles to avoid the possibility of future development of venous diseases. Pay attention to the position in which the child is sitting. Accustom him to sitting with the correct position of the legs: they should not be tightened and folded crosswise.
    • The best way to prevent future strokes is to lead a mobile lifestyle to prevent stagnation of blood in the lower extremities and prevent vein diseases.
    • Specialists recommend hardening and general strengthening procedures.
    • Children with this diagnosis need an annual vacation at the resort and regular walks in the fresh air.
    • Take care of a sufficient amount of drink that the child should drink every day.

    Do not let the child notice your concerns about his health – this can lead the baby to panic and increased nervous background. This will not contribute to improving his condition. Be always calm, good-natured and attentive to your child.

    Take care of his mental comfort. And over time, the transformations in the oval window of his heart will lead to its overgrowth. The main thing is to follow the recommendations of specialists. According to statistics, LLC, persisting after the age of five, is likely to accompany a person all his life.

    Often the window in the heart of the child does not have any special symptoms and does not interfere with the normal functioning of a person.

    Therefore, if a child does not want to continue to engage in intense sports, then in everyday life the window will not interfere with him in any way. But in the future, after 50 years, in the presence of concomitant diseases, this can complicate the course of diseases such as hypertension, heart failure, and also worsen the prognosis for recovery from heart attacks and strokes.

    If the oval window does not close in a timely manner, then this is still not attributed to flaws, but only to the features of the development of the heart. At the same time, people with a similar pathology are advised to limit physical activity. It is also necessary to visit a cardiologist once every six months and do a scheduled ultrasound scan.

    There is no reason for concern if the baby does not have additional diseases (other heart defects, diseases of the pulmonary system, circulatory disorders).

    This is due to the fact that an unclosed portion of the septum can only bother if there are other provoking factors. Also, in the presence of this pathology, it is prohibited:

    • to do weightlifting;
    • Scuba diving
    • dive to great depths from a springboard.

    Also, girls may have problems in the work of the heart during pregnancy in the future.

    Prevention

    Special methods for the prevention of an open oval window do not exist. So that a person does not have an oversized oval window, his pregnant mother must lead a healthy lifestyle:

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

    Prevention of heart defects in the fetus (violation of the structures of the heart) includes a number of concepts. A female requires:

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    Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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