Patent Foramen Ovale in Infants: When to Recheck?

Issues with the foramen ovale in infants?

Hello Doctor: My daughter was born at the Veterans General Hospital, where they performed an echocardiogram on newborns.
It was found that the foramen ovale in her heart had not yet closed.
The pediatrician advised us to return for a follow-up examination in three months.
After three months, the follow-up showed that it still had not closed, but the doctor mentioned that it had decreased in size.
We were advised to monitor it for a while longer.
Could you please advise when we should schedule the next examination? At what age do most children typically close the foramen ovale without the need for treatment? Thank you.

Xiao Yu, 30~39 year old female. Ask Date: 2001/04/24

Dr. Shi Zhongxian reply Pediatrics

Most children will close their patent ductus arteriosus (PDA) before the age of one or two.
Generally, as long as there are no associated congenital heart defects, it is not a concern, as some healthy individuals may not have complete closure even into adulthood, which does not adversely affect their health.
I recommend checking approximately every six months.

Reply Date: 2001/04/24

More Info

Patent Foramen Ovale (PFO) is a common condition in infants, where a small opening between the right and left atria of the heart fails to close after birth. This opening is a normal part of fetal circulation, allowing blood to bypass the lungs, which are not yet functioning. In most cases, the foramen ovale closes naturally within the first few months of life, but in some infants, it may remain open.

In your case, it is reassuring to hear that your pediatrician is monitoring your daughter's condition closely. The fact that the PFO was noted to be smaller during the follow-up examination is a positive sign. Generally, PFOs are considered to be of little concern unless they are associated with significant symptoms or complications, such as paradoxical embolism, which is rare in infants.

As for when to recheck, the timing can vary based on the individual case and the pediatric cardiologist's recommendations. Typically, if the PFO is small and asymptomatic, follow-up echocardiograms may be recommended at intervals of 6 to 12 months. In some cases, if the PFO is still present at 12 months of age and is small, many doctors may decide that further follow-up is unnecessary, as most PFOs will close spontaneously by the time the child reaches 2 to 3 years of age.

In terms of when a PFO is expected to close, studies suggest that about 75% of PFOs will close by the age of 2 years. By the age of 3, the majority of PFOs will have closed, and by the age of 5, it is quite rare for a PFO to remain open. If your daughter continues to show no symptoms and the PFO remains small, it is likely that she will not require any treatment.

In summary, I would recommend discussing with your pediatric cardiologist about scheduling the next echocardiogram in 6 to 12 months. If the PFO remains small and asymptomatic, it is likely that no further treatment will be necessary. Always keep an open line of communication with your healthcare provider regarding any concerns or changes in your child's health, as they can provide personalized guidance based on her specific situation.

In addition, it is essential to monitor for any signs of complications, such as unexplained shortness of breath, fatigue, or any neurological symptoms, and report these to your doctor promptly. Regular check-ups and following your pediatrician's recommendations will ensure that your daughter receives the best care possible as she grows.

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