{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:04:41Z","timestamp":1780639481067,"version":"3.54.1"},"reference-count":8,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The foramen ovale (FO) plays a central role in fetal circulation. Prenatal FO closure or restriction is well-characterized in fetuses and in neonates with congenital heart defects, but is rarely described as an isolated finding after birth. This study aimed to characterize the clinical presentation, echocardiographic features, management, and outcomes of neonates with isolated prenatal FO closure or restriction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 10 consecutive neonates admitted to our tertiary neonatal intensive care unit between September 2018 and August 2025 with FO closure or restriction diagnosed after birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median gestational age was 39\u2009+\u20091 weeks (range 36\u2009+\u20094\u201341\u2009+\u20091), and the median birth weight was 3,345\u2005g (range 2,600\u20134,000\u2005g). All the neonates presented within 9\u2005h after birth, nine of them with central or differential cyanosis, seven with associated respiratory distress, and one with apnea. Echocardiography uniformly revealed persistent pulmonary hypertension of the newborn (PPHN) and significantly impaired left ventricular (LV) function with preserved right ventricular (RV) contractility. The interatrial septum was closed in six neonates and was restrictive in four. A prostaglandin infusion was administered to nine neonates. All the patients received inotropic support and pulmonary arterial hypertension (PAH) therapy. In survivors, normalization of LV function occurred in 1\u20134 days, followed by transition to a predominant left-to-right ductus arteriosus (DA) shunt in 1\u20138 days. One neonate died from refractory LV failure and pulmonary hemorrhage; one developed global developmental delay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Isolated prenatal FO closure or restriction represents a distinct and likely under-recognized condition, causing severe neonatal PPHN associated with significant LV failure. These echocardiographic findings, together with preserved RV function, should prompt careful evaluation of the interatrial septum. Early recognition and hemodynamic support can lead to full recovery in the majority of cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1753196","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:39:49Z","timestamp":1780637989000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Isolated prenatal foramen ovale closure or restriction presenting after birth: a distinct, under-recognized clinical condition"],"prefix":"10.3389","volume":"14","author":[{"given":"Toma\u017e","family":"Podnar","sequence":"first","affiliation":[{"name":"Department of Pediatrics III (Paediatric Cardiology, Pulmonology, Allergology and Cystic Fibrosis), Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Geiger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics III (Paediatric Cardiology, Pulmonology, Allergology and Cystic Fibrosis), Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ira","family":"Winkler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics II (Neonatology), Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Griesmaier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics II (Neonatology), Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Sprung","sequence":"additional","affiliation":[{"name":"Innpath, Tirol Kliniken","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Kiechl-Kohlendorfer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics II (Neonatology), Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1007\/s00246-014-0879-5","article-title":"Diagnostic ultrasound features and outcome of restrictive foramen ovale in fetuses with structurally normal hearts","volume":"35","author":"Uzun","year":"2014","journal-title":"Pediatr Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1111\/echo.14009","article-title":"Isolated premature restriction or closure of foramen ovale in fetuses: echocardiographic characteristics and outcome","volume":"35","author":"Gu","year":"2018","journal-title":"Echocardiography"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2326","DOI":"10.1161\/01.CIR.0000128690.35860.C5","article-title":"Hypoplastic left heart syndrome with intact or highly restrictive atrial septum. Outcome after neonatal transcatheter atrial septostomy","volume":"109","author":"Vlahos","year":"2004","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1161\/01.CIR.0000144141.18560.CF","article-title":"Sensitivity and specificity of prenatal features of physiological shunts to predict neonatal clinical status in transposition of the great arteries","volume":"110","author":"Jouannic","year":"2004","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1007\/s00246-011-0032-7","article-title":"Benign outcome of pulmonary hypertension in neonates with a restrictive patent foramen ovale versus result for neonates with an unrestrictive patent foramen ovale","volume":"32","author":"Gupta","year":"2011","journal-title":"Pediatr Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1002\/jcu.23304","article-title":"Echocardiographic features and outcome of restrictive foramen ovale in fetuses with and without cardiac malformations: literature review","volume":"51","author":"Vena","year":"2023","journal-title":"J Clin Ultrasound"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-025-04055-5","article-title":"In utero diagnosis of premature closure of the foramen ovale: a retrospective case series analyzing neonatal interventions and maternal factors","author":"Kadish","year":"2025","journal-title":"Pediatr Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1017\/S1047951119003044","article-title":"Presumed prenatal closure of foramen ovale and persistent pulmonary hypertension of the newborn","volume":"30","author":"Stock","year":"2020","journal-title":"Cardiol Young"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1753196\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:39:50Z","timestamp":1780637990000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1753196\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":8,"alternative-id":["10.3389\/fped.2026.1753196"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1753196","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"article-number":"1753196"}}