Atrial Septal Defect, Ostium Primum Medication

  • Author: Shannon M Rivenes, MD; Chief Editor: Steven R Neish, MD, SM   more...
 
Updated: Aug 11, 2010
 

Medication Summary

Asymptomatic patients with ostium primum atrial septal defects (ASDs) require no medications. Those with evidence of congestive heart failure (CHF) warrant diuresis, traditionally using furosemide. Afterload reduction with an ACE inhibitor may also be prudent and may aid in the management of mitral regurgitation. Digitalis was traditionally thought to improve CHF by improving cardiac output and by increasing renal blood flow, with effects primarily related to an increase in cardiac contractility. Recently, its use has generally fallen out of favor for the management of CHF.

According to 2007 American Heart association (AHA) guidelines, subacute bacterial endocarditis prophylaxis is no longer warranted preoperatively; however, antibiotics for endocarditis prophylaxis are required for 6 months postoperatively. Patients with persistent atrioventricular (AV) valve abnormalities and/or significant mitral regurgitation adjacent to suture or patch material may require long-term prophylaxis before performing procedures that may cause bacteremia.

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Diuretic

Class Summary

These agents are used to relieve volume overload and pulmonary congestion in patients with CHF.

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Furosemide (Lasix)

 

Loop diuretic, acting on the thick ascending limb of the loop of Henle. It increases renal blood flow without increasing filtration rate. Its onset of action generally is within 1 h. Potassium, sodium, calcium, and magnesium excretion is increased. Titratable acid and ammonium excretion also are increased, which, in combination with a contraction of extracellular fluid volume, results in a metabolic alkalosis.

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Angiotensin-converting enzyme inhibitors

Class Summary

The primary indication for ACE inhibition for CHF and/or significant mitral regurgitation is to decrease afterload. These drugs cause a decrease in blood pressure with a concomitant decrease in systemic arteriolar resistance. Cardiac output, cardiac index, stroke volume, and stroke work increase, and the heart rate generally decreases. At the same time, renal blood flow increases and aldosterone secretion decreases, resulting in a beneficial natriuresis.

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Captopril (Capoten)

 

Rapidly absorbed, but bioavailability is significantly reduced with food intake. It achieves a peak concentration in an hour and has a short half-life. The drug is cleared by the kidney. Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

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Contributor Information and Disclosures
Author

Shannon M Rivenes, MD  Assistant Professor, Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine

Shannon M Rivenes, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, and American Society of Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Paul M Seib, MD  Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Medical Director, Cardiac Catheterization Laboratory, Co-Medical Director, Cardiovascular Intensive Care Unit, Arkansas Children's Hospital

Paul M Seib, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Arkansas Medical Society, International Society for Heart and Lung Transplantation, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Alvin J Chin, MD  Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM  Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association

Disclosure: Nothing to disclose.

References

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ECG from a patient with a partial atrioventricular septal defect. The PR interval is mildly prolonged. Left axis deviation with Q waves in leads I and aVL are present, consistent with a counterclockwise loop in the frontal plane. Right atrial enlargement and an rsR' pattern in the right chest leads also are noted.
Two-dimensional, apical, 4-chamber echocardiogram of a partial atrioventricular (AV) canal defect. The asterisk (*) delineates an area of dropout in the inferior atrial septum at the site of the primum atrial septal defect. The AV valves are separate but aligned at the same horizontal level, consistent with a 2-orifice common AV valve. In systole, the medial leaflets of the right- and left-sided AV valves demonstrate attachments to the crest of the interventricular septum, allowing no ventricular level shunting. RA = Right atrium; LA = Left atrium; RV = Right ventricle; LV = Left ventricle.
Gross pathology specimen viewed from the opened left atrium and left ventricle, demonstrating a partial atrioventricular (AV) canal defect. An ostium primum atrial septal defect (ASD) marked by an asterisk (*) is visualized in the inferior aspect of the interatrial septum. An ostium secundum ASD marked by 2 asterisks (**) is also noted. The mitral valve is cleft and the leaflets are thickened and rolled, suggestive of chronic mitral regurgitation. LA = Left atrium; LV = Left ventricle; MV = Mitral valve.
 
 
 
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