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Updated: Jan 11, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Follow-Up of Neonatally Diagnosed Atrial Septal Defects and Patent Foramen Ovale at Preschool Age
Sofie Dannesbo1, Anna Maria Dehn2, Elisabeth Blixenkrone-Møller3
1Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Insights
Most neonatal interatrial communications (IACs) close spontaneously. An algorithm effectively identifies newborns with atrial septal defects (ASDs) who require follow-up, as they have a higher risk of persistent ASD.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Interatrial communications (IACs) are common in newborns, including patent foramen ovale (PFO) and atrial septal defects (ASDs).
- Distinguishing between PFOs and ASDs in neonates is challenging, impacting decisions on follow-up and treatment.
- A previously developed algorithm aids in classifying neonatal IACs.
Purpose of the Study:
- To evaluate the patency of neonatal IACs at preschool age using a previously developed classification algorithm.
- To assess the long-term outcomes of IACs identified in newborns.
Main Methods:
- Reexamined 1,099 children from the Copenhagen Baby Heart Study who had neonatal transthoracic echocardiography (TTE).
- Neonatal TTEs were classified using an algorithm distinguishing ASDs (defect size ≥4 mm, abnormal location, or multiple) from PFOs.
- Follow-up TTEs reclassified IAC patency in children with neonatal ASD, PFO, or no IAC.
Main Results:
- High spontaneous closure rates observed: 81.7% for neonatal ASD and 89.9% for neonatal PFO.
- Children with neonatal ASD were significantly more likely (OR 8.2) to have persistent ASD at follow-up compared to PFO or no IAC.
- Four children with neonatal ASD required surgical closure; 5.0% of those without neonatal IAC had a follow-up IAC.
Conclusions:
- Spontaneous closure rates for neonatal IACs are high across all types.
- The algorithm effectively identifies neonatal ASDs, indicating a higher risk of persistent ASD and supporting targeted follow-up.
- The study validates the algorithm's utility in managing newborns with IACs, recommending focused follow-up for neonatal ASDs only.
Background:
Interatrial communications (IACs) are common in newborns. While most close spontaneously, some persist as patent foramen ovale (PFO) or atrial septal defects (ASDs). While PFOs are mostly benign, ASDs may require surveillance and treatment. Distinguishing ASDs from PFOs in newborns and deciding who requires follow-up can be challenging. We previously developed an algorithm to improve classification of IACs in newborns. This study aimed to evaluate the patency at preschool age of neonatal IACs classified using the algorithm.
Methods:
We reexamined children from the Copenhagen Baby Heart Study who underwent neonatal transthoracic echocardiography (TTE). Neonatal TTEs were previously classified into PFO and ASD subtypes using our algorithm. ASDs were distinguished from PFOs by defect size ≥4 mm, abnormal location, or multiple communications. For this study, we reexamined >200 children with each type of neonatal IAC and >200 without a neonatally identified IAC. Patent IACs at follow-up were reclassified using the algorithm.
Results:
We reexamined 1,099 children (median age, 5.2 [interquartile range, 4.9-5.5] years; 53% female): 290 with neonatal ASD, 608 with neonatal PFO, and 201 without neonatal IAC. At follow-up, spontaneous closure, that is, no detectable residual shunt by color Doppler, was observed in 81.7% of children with neonatal ASD (n = 237) and in 89.9% of children with neonatal PFO (n = 546). Among children without neonatally identified IACs, the follow-up TTE revealed an IAC in 5.0% (n = 10). Children with a neonatal ASD were 8 times more likely to have an ASD at follow-up than children with a neonatal PFO or no neonatal IAC (adjusted odds ratio, 8.2; 95% CI 3.6-18.7; P < .0001). Four children, all with neonatal ASDs, required surgical ASD closure.
Conclusions:
Spontaneous closure rates of all neonatal IAC types were high. Children classified by the algorithm as having neonatal ASD had a significantly higher risk of persistent ASD, supporting its value in identifying newborns who may benefit from follow-up and recommending targeted follow-up of neonatal ASDs only.
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