Early neonatal surgery for congenital heart defects after prenatal diagnosis of restricted foramen ovale as the priority procedure?

Open access


From 2012-2014 we selected fetuses who had an isolated congenital heart defect and restriction of the foramen ovale defined as its diameter of 4 mm or less, shunt across foramen ovale, V max > 70 cm/sec along with a typical harsh sound during fetal ausculation during echocardiography and reversal flow in pulmonary veins, no extracardiac anomalies, singleton pregnancies and delivery > 37 weeks of gestation. It was retrospective analysis of 16 cases: There were 10 non-survivors and 6 survivors The only significant difference between survivors and non-survivors pertained to the fraction of newborns operated on up to 11th day, which was significantly higher among the survivors (5/6 vs. 2/8, p=0.031).


1) In the event of prenatal restriction of the foramen ovale early surgery by day 10 had a statistically better outcome in terms of survival compared to cases that underwent surgery at a later period at our Institute.

2) Prenatal restriction of the foramen ovale was more often related to male gender and in 75% of cases in our series had complicated follow-up: neonatal death or prolonged hospital stay.3) Information from prenatal echocardiography regarding restriction of the foramen ovale should be taken into consideration as valuable information suggesting priority for early cardiac surgery.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Hagen A M Albig L Schmitz. 2005. “Prenatal diagnosis of isolated foramen ovale obstruction: a report of two cases”. Fetal Diagn Ther 20:70-73. doi:10.1159/000081373

  • 2. Naeye RL WA Blanc. 1964. “Prenatal Narrowing or Closure of the Foramen Ovale”. Circulation 30:736-742. doi:10.1161/01.CIR.30.5.736

  • 3. Uzun O K Babaoglu YI Ayhan YI et al. 2014. “Diagnostic ultrasound features and outcome of restrictive foramen ovale in fetuses with structurally normal hearts”. Pediatr Cardiol 35:943-952. doi:10.1007/s00246-014-0879-5

  • 4. Radzymińska-Chruściel B A Nawara-Baran. 2012. [The echocardiographic view of isolated restriction of foramen ovale - the case report]. Prenat Cardio 2 (3): 21-24. [Polish]

  • 5. Donofrio MT YA Bremer WB Moskowitz. 2004. “Diagnosis and management of restricted or closed foramen ovale in fetuses with congenital heart disease”. Am J Cardiol. 94:1348-1351. doi:10.1016/j.amjcard.2004.07.133

  • 6. Nowlen TT NA Ayres DL Kearney MR Nihill RG Grifka. 2000. “Premature closure of the foramen ovale associated with aortic stenosis left ventricular dilation with thrombus and early mortality”. Am J Cardiol 85:1159-1161. doi:10.1016/S0002-9149(00)00718-9

  • 7. Chiou HL A Moon-Grady R Rodriguez T Konia M Parrish J Milstein. 2008. “A rare lethal combination of premature closure of the foramen ovale and d-transposition of the great arteries with intact ventricular septum”. Int J Cardiol 130 (2):57-59. doi:10.1016/j.ijcard.2007.11.055

  • 8. Donofrio MT. 2002. “Images in cardiovascular medicine. Premature closure of the foramen ovale and ductus arteriosus in a fetus with transposition of the great arteries”. Circulation 105:65-66. doi:10.1161/hc1102.105232

  • 9. Maeno YV SA Kamenir B Sinclair ME van der Velde JF Smallhorn LK Hornberger. 1999. “Prenatal features of ductus arteriosus constriction and restrictive foramen ovale in d-trans- position of the great arteries”. Circulation 1999:1209-1214

  • 10. Silver MM M Zielenska D Perrin JK MacDonald. 1995. “Association of prenatal closure of the foramen ovale and fetal parvovirus B19 infection in hydrops fetalis”. Cardiovasc Pathol 94 (4):103-109. doi:10.1016/1054-8807(94)00029-Q

  • 11. Chrysostomou C RL Romaguera MM Rodriguez. 2005. “Giant aneurysm of the atrial septum associated with premature closure of foramen ovale”. Cardiovasc Ultrasound 20 (3). doi:10.1186/1476-7120-3-20.

  • 12. Pesonen E H HaavistoP Amma ̈la ̈ K Teramo. 1983. “Intrauterine hydrops caused by premature closure of the foramen ovale”. Arch Dis Child 58:1015-1016

  • 13. Olson RW M NishibatakeS Arya EF Gilbert. 1987. “Nonimmunologic hydrops fetalis due to intrauterine closure of fetal foramen ovale”. Birth Defects 23:433-442

  • 14. Feit LR JA Copel CS Kleinman. 1991. “Foramen ovale size in the normal and abnormal human fetal heart: an indicator of transatrial flow physiology”. Ultrasound Obstet Gynecol 1:313-319

  • 15. Phillipos EZ MA Robertson KD Still. 1994. “The echocardiographic assessment of the human fetal foramen ovale”. J Am Soc Echocardiogr 7:257-263

  • 16. Kiserud T S Rasmussen. 2001. “Ultrasound assessment of the fetal foramen ovale”. Ultrasound Obstet Gynecol 17:119-124. doi:10.1046/j.1469-0705.2001.00331.x.

  • 17. Punn R NH Silverman. 2011. “Fetal predictors of urgent balloon atrial septostomy in neonates with complete transposition”. J Am Soc Echocardiogr 24:425-430

  • 18. Respondek-Liberska M J Szymkiewicz-Dangel Z Tobota M Słodki. 2008. „Założenia i wstępne wnioski Ogolnopolskiego Rejestru Patologii Kardiologicznych Płodow (www.orpkp.pl)”. Polski Przegląd Kardiologiczny 10 (2): 19-23

  • 19. Respondek-Liberska M K Janiak. 2004. “Prenatal ductal constriction (DC) and prenatal foramen ovale (FO) closure in otherwise normal heart anatomy in referral center for fetal echocardiography”. Ultrasound in Obstetrics & Gynecology 24:276-277

  • 20. Li Y-D Z-A Li Y-H He. 2013. “Premature closure or restriction of the foramen ovale: prenatal diagnosis by directional enhanced flow imaging”. J Ultrasound Med. 32: 1291-1294. doi:10.7863/ultra.32.7.1291

  • 21. Glatz JA S Tabbutt JW Gaynor et al. 2007. “Hypoplastic Left Heart Syndrome With Atrial Level Restriction in the Era of Prenatal Diagnosis”. Ann Thorac Surg. 84:1633-1638. doi:10.1016/j.athoracsur.2007.06.061.

  • 22. Słodki M M Respondek-Liberska. 2013. “Hypoplastic left heart syndrome at the tertiary fetal cardiac center: as planned urgent or severest congenital heart disease? Prenatal classification for obstetricians and neonatologists”. Prenat Cardio 3 (4): 23-27

  • 23. Vlahos AP JE Lock DB McElhinney ME Van Der Velde. 2004. “Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: Outcome after neonatal transcatheter atrial septostomy”. Circulation 109:2326-2330. doi:10.1161/01.CIR.0000128690.35860.C5.

  • 24. Divanović A K Hor J Cnota R Hirsch M Kinsel-Ziter E Michelfelder. 2011. “Prediction and perinatal management of severely restrictive atrial septum in fetuses with critical left heart obstruction: Clinical experience using pulmonary venous Doppler analysis”. J Thorac Cardiovasc Surg 141:988-994. doi:10.1016/j.jtcvs.2010.09.043

  • 25. Taketazu M C Barrea JF Smallhorn GJ Wilson LK Hornberger. 2004. “Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome”. J Am Coll Cardiol 43 (10):1902-1907. doi:10.1016/j.jacc.2004.01.033

  • 26. Donofrio MT. 2005. “Innovations in fetal cardiology”. Heart Views 6 (1): 5-17

  • 27. Kalish BT W Tworetzky CB Benson et al. 2014. “Technical challenges of atrial septal stent placement in fetuses with hypoplastic left heart syndrome and intact atrial septum”. Catheter Cardiovasc Interv 84:77-85. doi:10.1002/ ccd.25098

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 229 72 4
PDF Downloads 93 28 0