Patent Foramen Ovale in Children: Is Closure Necessary? - Pediatrics

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Patent Foramen Ovale (PFO) is a condition where a small opening between the two upper chambers of the heart (the atria) fails to close after birth. This opening is normal in fetal development, allowing blood to bypass the lungs, which are not yet functioning. In most cases, the foramen ovale closes naturally within the first year of life. However, in some individuals, it remains open, which can lead to various health concerns.

In your case, you have two children with PFO, and you are concerned about whether closure is necessary, especially given the symptoms exhibited by your older child, such as the sudden episode of fainting. The decision to close a PFO is not straightforward and depends on several factors, including the size of the opening, the presence of symptoms, and any associated heart conditions.


Key Considerations for PFO Closure:
1. Symptoms: The most critical factor in deciding whether to close a PFO is whether the child has experienced symptoms that could be related to the PFO. In your older child's case, the episode of fainting and the associated symptoms (like lips turning pale) could potentially indicate a transient ischemic attack (TIA) or a paradoxical embolism, where a blood clot passes through the PFO and into the systemic circulation, potentially leading to serious complications. If such symptoms are recurrent or concerning, closure may be recommended.

2. Size of the PFO: The size of the PFO can also influence the decision. A larger PFO (greater than 2-3 mm) is more likely to be associated with significant shunting of blood and may warrant closure, especially if accompanied by symptoms. In your case, the older child has a PFO of 0.66 cm, which is relatively significant, while the younger child has a smaller PFO of 0.30 cm. The larger size in the older child could be a factor in considering closure.

3. Associated Conditions: The presence of other heart conditions, such as mitral regurgitation or pulmonary artery stenosis, can complicate the situation. In both children, the mild mitral regurgitation and right-sided pulmonary artery narrowing should be evaluated in conjunction with the PFO. A cardiologist may consider these factors when assessing the overall risk and benefit of closure.

4. Age and Development: The age of the children is also a consideration. In younger children, especially those without symptoms, a conservative approach may be taken, with regular monitoring. However, in older children, particularly those who are symptomatic, intervention may be more strongly considered.

5. Risk of Complications: The risks associated with the closure procedure itself must also be weighed against the potential benefits. While PFO closure is generally safe, it is still an invasive procedure that carries risks, including infection, bleeding, and complications related to anesthesia.


Recommendations:
Given the complexities involved, it is crucial to have a thorough evaluation by a pediatric cardiologist. They will likely perform echocardiograms and possibly other imaging studies to assess the PFO and any associated heart conditions. They may also consider conducting tests to evaluate the risk of paradoxical embolism, especially in light of your older child's symptoms.

In conclusion, while not all children with PFO require closure, your older child's symptoms and the size of the PFO suggest that a careful evaluation is warranted. The younger child's smaller PFO may not necessitate immediate intervention, but ongoing monitoring is essential. A pediatric cardiologist will provide the best guidance tailored to your children's specific situations.