Ostium Primum Atrial Septal Defects Medication
- Author: Shannon M Rivenes, MD; Chief Editor: P Syamasundar Rao, MD more...
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.
These agents are used to relieve volume overload and pulmonary congestion in patients with CHF.
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.
Angiotensin-converting enzyme inhibitors
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.
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.
Rana MS, Theveniau-Ruissy M, De Bono C, et al. Tbx1 coordinates addition of posterior second heart field progenitor cells to the arterial and venous poles of the heart. Circ Res. 2014 Oct 10. 115(9):790-9. [Medline].
Sinha R, Thangaswamy CR, Muthiah T, Chandra P, Subramaniam R. Prolonged postoperative desaturation in a child with Down syndrome and atrial septal defect. Indian J Anaesth. 2011 Nov. 55(6):608-10. [Medline]. [Full Text].
Najm HK, Williams WG, Chuaratanaphong S, et al. Primum atrial septal defect in children: early results, risk factors, and freedom from reoperation. Ann Thorac Surg. 1998 Sep. 66(3):829-35. [Medline].
Michielon G, Stellin G, Rizzoli G, Milanesi O, Rubino M, Moreolo GS, et al. Left atrioventricular valve incompetence after repair of common atrioventricular canal defects. Ann Thorac Surg. 1995 Dec. 60(6 Suppl):S604-9. [Medline].
Stulak JM, Burkhart HM, Dearani JA, et al. Reoperations after repair of partial atrioventricular septal defect: a 45-year single-center experience. Ann Thorac Surg. 2010 May. 89(5):1352-9. [Medline].
Bergin ML, Warnes CA, Tajik AJ, Danielson GK. Partial atrioventricular canal defect: long-term follow-up after initial repair in patients > or = 40 years old. J Am Coll Cardiol. 1995 Apr. 25(5):1189-94. [Medline].
Kaza AK, Colan SD, Jaggers J, et al. Surgical interventions for atrioventricular septal defect subtypes: the pediatric heart network experience. Ann Thorac Surg. 2011 Oct. 92(4):1468-75; discussion 1475. [Medline]. [Full Text].
Aeba R, Kudo M, Okamoto K, Yozu R. Bridging annuloplasty for left atrioventricular valve of partial atrioventricular septal defect. Ann Thorac Surg. 2012 May. 93(5):e137-9. [Medline].
Morris CD, Reller MD, Menashe VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA. 1998 Feb 25. 279(8):599-603. [Medline].
Gil-Jaurena JM, Zabala JI, Conejo L, Cuenca V, Picazo B, Jiménez C, et al. Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches. Rev Esp Cardiol. 2011 Mar. 64(3):208-12. [Medline].
Murashita T, Kubota T, Oba J, et al. Left atrioventricular valve regurgitation after repair of incomplete atrioventricular septal defect. Ann Thorac Surg. 2004 Jun. 77(6):2157-62. [Medline].
Agny M, Cobanoglu A. Repair of Partial Atrioventricular Septal Defect in Children Less than Five Years of Age: Late Results. Ann Thorac Surg. 1999 May. 67(5):1412-4. [Medline].
Arky, Ronald. Physicians' Desk Reference. 52nd ed. Montvale, NJ: Medical Economics Co Inc; 1998. 784-7, 1051-1062, 1219-1221.
Castaneda AR, Jonas RA, Mayer JE. Atrioventricular canal defect. Cardiac Surgery of the Neonate and Infant. 1994. 167-86.
Cheitlin MD, Douglas PS, Parmley WW. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Task Force 2: acquired valvular heart disease. J Am Coll Cardiol. 1994 Oct. 24(4):874-80. [Medline].
Del Nido PJ, Bichell DP. Minimal-access surgery for congenital heart defects. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 1998. 1():75-80. [Medline].
Garson A Jr, Bricker JT, Fisher DJ. The Science and Practice of Pediatric Cardiology. Williams & Wilkins; 1998. 2nd ed: 1158-179.
Giamberti A, Mazzera E, Di Chiara L, Ferretti E, Pasquini L, Di Donato RM. Right submammary minithoracotomy for repair of congenital heart defects. Eur J Cardiothorac Surg. 2000 Dec. 18(6):678-82. [Medline].
Gilman AG, Goodman LS, Nies AS. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. 1990. 721-5, 749-63, 814-839.
Graham TP Jr, Bricker JT, James FW, Strong WB. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Task Force 1: congenital heart disease. J Am Coll Cardiol. 1994 Oct. 24(4):867-73. [Medline].
Kaur A, Srivastava S, Lytrivi ID, Nguyen K, Lai WW, Parness IA. Echocardiographic evaluation and surgical implications of common atrioventricular canal defects with absent or diminutive ostium primum defect. Am J Cardiol. 2008 Jun 1. 101(11):1648-51. [Medline].
Lange A, Mankad P, Walayat M, et al. Transthoracic three-dimensional echocardiography in the preoperative assessment of atrioventricular septal defect morphology. Am J Cardiol. 2000 Mar 1. 85(5):630-5. [Medline].
Marino B, Digilio MC, Toscano A, et al. Congenital heart diseases in children with Noonan syndrome: An expanded cardiac spectrum with high prevalence of atrioventricular canal. J Pediatr. 1999 Dec. 135(6):703-6. [Medline].
Perloff JK. The Clinical Recognition of Congenital Heart Disease. 4th ed. WB Saunders; 1994. 349-80.
Pretre R, Dave H, Kadner A, Bettex D, Turina MI. Direct closure of the septum primum in atrioventricular canal defects. J Thorac Cardiovasc Surg. 2004 Jun. 127(6):1678-81. [Medline].
Sadler TW. Langman's Medical Embryology. 5th ed. Baltimore, MD: Williams & Wilkins; 1985. 176-84.
Snider AR, Serwer GA, Ritter SB. Echocardiography in Pediatric Heart Disease. 2nd ed. Harcourt Health Sciences Group; 1997. 277-89.
Zanchetta M, Rigatelli G, Pedon L, et al. Role of intracardiac echocardiography in atrial septal abnormalities. J Interv Cardiol. 2003 Feb. 16(1):63-77. [Medline].