For many people, visiting a pediatric cardiologist can be quite a nerve-racking experience! While we at Pediatric Heart Specialists take pride in making your experience as comfortable as possible, it is natural that any diagnosis given to your child, simple or complex, can cause concern and even confusion. For example, it’s quite common that many questions may arise when your physician tells you that your child has a normal “hole” in the heart. A hole? Normal?? What exactly are we talking about???
The medical term for this finding is called a patent foramen ovale, or PFO for short. What this refers to is a “flap” open within the wall (septum) that separates the heart’s right and left upper chambers (known as the atria). Prior to birth, this flap is normal, and if fact necessary for normal fetal blood flow. The foramen ovale allows the blood to bypass the fetus’ lungs (which don’t receive oxygen until the baby’s first cry), and ultimately return to the mother for proper oxygen exchange.
After birth, the natural changes within the heart and lungs allow this flap to seal in around 75-80% of individuals. In the other 20-25%, this opening remains, and this hole is then known as a patent foramen ovale. The exact cause of a persistent PFO is not known, but by itself, a PFO rarely causes any symptoms or complications. In fact, with more complex heart disease, a PFO may be necessary for the newborn to stabilize before surgery. Overall, a PFO in an otherwise normal baby can often be considered a normal variant.
The location of a PFO within the wall can be very similar to a “true” hole, or atrial septal defect (ASD, for short). In certain cases, it may be challenging to distinguish a small ASD from a PFO, and repeat studies may be needed. A PFO usually closes within a few years of birth, while an ASD may remain. Overall, the prognosis of a child with a PFO is excellent, as 99% of individuals will not show symptoms or need treatment. As always, please consult your physician or one of us as PHS with any other questions.
Amit Verma, M.D.
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