Can Medications Treat Patent Foramen Ovale in Children?

Is medication treatment available for a patent foramen ovale in children?

I have a few questions for the doctor: 1.
My child has a patent foramen ovale (PFO) with a size of 2.5mm.
The doctor mentioned there is a 95% chance it will close.
Is 2.5mm considered small? Will it close? 2.
I heard that a patent foramen ovale can be treated with medication.
Is that true? 3.
I also heard that a patent foramen ovale can cause asthma.
Is that true? Please help me with these questions, thank you!

Danxin de mama, 30~39 year old female. Ask Date: 2004/10/29

Dr. Cai Zhengxian reply Pediatrics

Dear concerned mother,
The foramen ovale is a necessary cardiac opening in the fetus while in the mother's womb, which maintains important blood circulation.
After birth, about 70% of newborns will close it immediately, and 90% will close it within three months.
If it remains open beyond three months, we refer to it as a persistent foramen ovale (PFO).
If your baby is currently under three months old, there is indeed over a 90% chance it will close on its own.
However, if your baby is older than three months and still has a persistent foramen ovale, it is advisable to consult a pediatric cardiologist.
I have consulted Dr.
Wang from the pediatric cardiology department at Cheng Kung University Hospital for his opinion.
Please consider the following: a persistent foramen ovale larger than 20mm may lead to hemodynamic changes, and a diameter greater than 50mm is classified as a large persistent foramen ovale, which can cause significant pulmonary blood flow shunting (Qp/Qs) greater than four times.
Although there may be more than four times the shunting, newborns typically do not exhibit any unusual symptoms.
Such a large persistent foramen ovale may only be discovered during school age when the child shows slower growth or poor exercise tolerance.
As for smaller persistent foramen ovale, they may never present any symptoms throughout life.
Since this is a congenital anomaly present in utero, there are currently no medications available for treatment; the only viable options are surgical intervention or catheter-based treatment.
Therefore, our recommendations are as follows: if your baby is still under three months old, please ensure regular follow-up examinations.
If your baby is older than three months and has a persistent foramen ovale, and its diameter is not large, you can follow up every six months.
If it closes on its own or shows no hemodynamic changes, treatment may not be necessary, and only monitoring and observation are required.
Regarding whether an unclosed foramen ovale can cause asthma, it likely refers to a large persistent foramen ovale causing poor exercise tolerance in school-aged children, leading to rapid breathing.
This is not related to allergic bronchial asthma.
Additionally, if an adult has a persistent foramen ovale, the need for treatment depends on whether they have experienced an embolic stroke.
If an adult has had a stroke and also has a persistent foramen ovale, aggressive treatment is necessary to prevent the risk of recurrence.
Tainan Municipal Hospital cares about you, and if you have any further questions, please feel free to ask!

Reply Date: 2004/10/29

More Info

Patent Foramen Ovale (PFO) is a common congenital heart defect characterized by a small opening between the left and right atria of the heart. This opening is a normal part of fetal circulation, allowing blood to bypass the lungs, but it typically closes shortly after birth. In some individuals, however, it remains open, which can lead to various health concerns. Let's address your questions one by one.

1. Is a 2.5mm PFO considered small, and what are the chances of it closing?
A PFO measuring 2.5mm is indeed considered relatively small. Studies indicate that smaller PFOs have a higher likelihood of closing spontaneously over time. In fact, the majority of PFOs, especially those less than 3mm, may close on their own within the first few years of life. The 95% chance of closure mentioned by your physician is consistent with current medical understanding. Regular follow-ups with a pediatric cardiologist can help monitor the situation and determine if any intervention is necessary.

2. Can medications treat PFO?
Currently, there are no specific medications that can close a PFO. The management of a PFO typically involves monitoring, especially if the child is asymptomatic. In some cases, if a PFO is associated with complications such as stroke or significant shunting of blood, a procedure may be recommended. This can involve either a catheter-based closure or, in some cases, surgical intervention. Medications may be prescribed to manage symptoms or associated conditions (like migraines or transient ischemic attacks), but they do not directly affect the PFO itself.

3. Can a PFO cause asthma?
The relationship between PFO and asthma is not straightforward. While some studies suggest that there may be an association between PFO and certain respiratory conditions, including asthma, the evidence is not conclusive. Asthma is primarily an inflammatory condition of the airways, influenced by genetic, environmental, and immunological factors. If your child has asthma, it is essential to manage it with appropriate medications and lifestyle adjustments, rather than attributing it solely to the presence of a PFO.

In summary, a 2.5mm PFO is generally considered small with a high chance of spontaneous closure. There are no medications that can close a PFO, and while there may be some associations with respiratory issues, asthma is primarily influenced by other factors. Regular follow-up with a pediatric cardiologist is crucial to monitor your child's condition and ensure appropriate management. If you have further concerns or if your child exhibits symptoms such as unexplained shortness of breath or other respiratory issues, do not hesitate to consult with your healthcare provider for a comprehensive evaluation.

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