All babies are born with a hole in the wall between the upper heart chambers called a patent foramen ovale (PFO). Typically these range from 2-4 mm in size. A 6 mm PFO is larger than the norm, but the natural history is that MOST children will gradually close these over the first 2 years of life. It is still normal to see a PFO in a 21 day old baby. It is impossible to predict if an intervention will ultimately be required at this early time. Your child could be re-evaluated between 6 and 12 months of age to see if the hole is still open by echocardiography. It likely will be gone by then, but if not, follow up could be done at a later time. The indications to close a true atrial septal defect (ASD) include enough blood flow across the hole to enlarge the right sided heart chambers. So you have time on your side to make things better.
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