Patent Foramen Ovale in Infants: Key Questions Answered

Patent foramen ovale (PFO)

Hello Dr.
Hsiao, I would like to ask you a few questions.

1.
My baby is 4 months old.
During the newborn echocardiogram, the doctor noted a 0.13 mm gap in the foramen ovale.
In today's 4-month check-up, the gap measured 0.474 mm.
Since these two examinations were conducted by different doctors, is it possible that the differences in results are due to variations in the doctors' techniques?
2.
Can the foramen ovale enlarge? If it can enlarge, is it possible for it to increase by 0.3 mm in just 4 months? During this time, my baby has been doing well, not crying excessively, and has been feeding normally.
Everything seems to be fine.
3.
What is the approximate chance of closure for a 0.474 mm gap?
4.
At what size does the foramen ovale need to be before it is classified as an atrial septal defect (ASD)? I have asked several people, and each has given a different answer.
Some say 6 months, others say 1 year, and some say as long as it continues to decrease, there is a chance of closure before the age of 5.
Is this information accurate?
Thank you very much for answering these questions.

Xinji de baba, 30~39 year old female. Ask Date: 2012/03/11

Dr. Xiao Kaiwen reply Pediatrics

1.
Echocardiography is a highly skill-dependent examination, and the accuracy of the results can vary based on the operator's experience and technique, as well as the baby's level of cooperation at the time of the exam.
2.
The foramen ovale typically gradually decreases in size and may close, but it can also slightly enlarge as the baby grows and the heart develops.
3.
Approximately 80% of foramen ovale cases will close spontaneously (there is no statistical data on size) (0.474 mm is actually not large).
4.
The foramen ovale is located on the septum between the left and right atria and is a normal structure during fetal development.
Therefore, strictly speaking, a patent foramen ovale is not considered an atrial septal defect; it is more likely to close spontaneously compared to an atrial septal defect, and many individuals remain asymptomatic throughout their lives.
Even in cases of atrial septal defects, some individuals may never require intervention, unless the defect is large enough to cause right ventricular enlargement or symptoms of heart failure.
Generally, there is no urgent need for treatment; regular follow-up with your pediatric cardiologist is sufficient, and there is no specific age at which treatment must occur.

Reply Date: 2012/03/11

More Info

Patent Foramen Ovale (PFO) is a common condition in infants where a small opening exists between the left and right atria of the heart. This opening is a normal part of fetal circulation, allowing blood to bypass the lungs, which are not yet in use. After birth, this opening typically closes as the newborn begins to breathe air, but in some cases, it remains open, leading to a PFO.

1. Variability in Measurements: It's not uncommon for different echocardiographers to report slightly different measurements of a PFO. Variability can arise from several factors, including the technique used, the angle of the ultrasound probe, and the baby's position during the examination. A difference of 0.3 mm, as you've noted, could be attributed to these factors. It's essential to consider the clinical context and whether the baby is showing any symptoms or complications related to the PFO.

2. Can a PFO Change Size?: Yes, a PFO can appear to change in size over time. The size of the opening can fluctuate based on various factors, including changes in pressure within the heart chambers and the overall hemodynamic status of the infant. In your case, the increase from 0.13 mm to 0.474 mm is notable, but it’s important to remember that the clinical significance of these measurements is more critical than the absolute size. If your baby is otherwise healthy and asymptomatic, this may not be a cause for concern.

3. Closure Probability: The likelihood of spontaneous closure of a PFO varies. Studies suggest that many PFOs close within the first year of life, especially if they are small. The probability of closure decreases as the child grows older. While specific statistics can vary, many experts suggest that a PFO of less than 5 mm has a reasonable chance of closing spontaneously, especially in the first few years of life. For your baby’s current measurement of 0.474 mm, there is still a chance for closure, but it is difficult to quantify precisely without further monitoring.

4. Criteria for Diagnosis of Atrial Septal Defect (ASD): The transition from a PFO to a diagnosis of an atrial septal defect (ASD) typically depends on the size and persistence of the opening. While there is no universally agreed-upon cutoff, many clinicians consider a PFO to be an ASD if it remains open beyond 1 year of age and is larger than 2 mm. The general consensus is that if the PFO is still present and not closing by the time the child is 5 years old, it may be classified as an ASD, especially if it is causing any hemodynamic changes or symptoms.

In summary, your baby's PFO is being monitored, and it is essential to maintain regular follow-ups with a pediatric cardiologist. They will assess the situation based on the size of the PFO, any symptoms, and the overall health of your child. If the PFO remains small and your baby continues to thrive, there may be no need for intervention. However, if there are any concerns or changes in your baby's condition, further evaluation may be warranted. Always feel free to discuss any concerns with your healthcare provider, as they can provide personalized guidance based on your baby's specific situation.

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