How is patent foramen ovale diagnosed?

Question

Hello doctor,

My 11-year-old daughter has been experiencing intermittent chest pains and a fast pulse for about 18 to 24 months. She has had a normal ECG and physical examination, but an echocardiogram has shown a mobile interatrial septum with left-to-right flow. It identified a small atrial septal defect (ASD) with a diameter of approximately 2.1 mm, visible through color flow. No chamber enlargement or increased flow is seen through the RVOT/PV. I have taken these details from a letter sent from the pediatrician to the pediatric cardiologist.

I do not know how long we will be waiting for an appointment, and over the phone, I was simply told they found a small hole in her heart. While I understand the basic issue, I would like to clarify a few things: Are the mobile interatrial septum and the ASD or PFO (patent foramen ovale) two separate problems? Does this mean she has an aneurysm as well as a hole? Does the 2.1 mm refer to the actual size or diameter of the hole or something else? Is she safe to engage in normal activities like exercise? We also have a holiday booked, will it be safe for her to fly?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

Sorry to hear about your daughter's health issues.

Atrial septal defect (ASD) and patent foramen ovale (PFO) are two different conditions. No, there is no evidence of an aneurysm. Based on the findings, it is more suggestive of a PFO than an ASD. In most cases of ASD, there would be chamber involvement or enlargement. From my experience, most ASDs are between 6 to 7 mm in size. A transesophageal echocardiogram (TEE) is typically used to confirm a PFO rather than a regular echocardiogram. The 2.1 mm measurement refers to the size of the hole. Yes, she can participate in normal physical activities and is safe to fly.

However, I advise keeping an eye on her, just in case there are any changes. She will likely be fine. I doubt her symptoms are related to the defect, as most patients do not have symptoms and live a normal life. Those who do typically present symptoms after the age of 35 to 40.

I hope this helps you.

Thank you.