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Aortopulmonary Septal Defect Medication

  • Author: Barry A Love, MD; Chief Editor: Stuart Berger, MD  more...
 
Updated: Feb 05, 2015
 

Medication Summary

Digitalis and diuretics may be used to palliate this condition for a short time before surgical repair as discussed in Medical Care.

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Cardiac Glycoside

Class Summary

Digitalis may be used in the management of congestive heart failure (CHF). It exerts positive inotropic effect, which increases the force of contraction of the myocardium. The mode of action by which digitalis improves symptoms is complex but probably results from both increased cardiac contractility and neurohormonal actions.

Digoxin (Lanoxicaps, Lanoxin)

 

Cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

May be given as a loading dose followed by a maintenance dose or simply as a maintenance regimen. Digitalis loading increases hazards of this drug. In management of CHF, little, if any, indication for digoxin loading is warranted. For more immediate inotropy, use IV beta-agonists.

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Diuretics

Class Summary

These agents improve symptoms by decreasing total body water, thereby decreasing pulmonary fluid and improving breathlessness. They promote excretion of water and electrolytes by the kidneys. They are used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention has resulted in edema or ascites. Use multiple strategies to medically manage CHF in infancy. Carefully monitor fluid status and electrolyte balance of infants on anticongestive medications.

Furosemide (Lasix)

 

Increases excretion of water by interfering with chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule. It is a very effective diuretic yet may cause significant potassium loss.

Chlorothiazide (Diuril)

 

Thiazide diuretic acts at the distal part of the nephron to inhibit sodium and chloride reabsorption. Used alone, this agent typically elicits a modest diuresis; however, when combined with furosemide, effects of both agents are potentiated with a potent diuretic effect.

Spironolactone (Aldactone)

 

Potassium-sparing diuretic that works on the distal tubule to inhibit sodium/potassium exchange at the aldosterone site. Although a weak diuretic alone, it helps limit potassium loss when used with other potent diuretics.

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Contributor Information and Disclosures
Author

Barry A Love, MD Assistant Professor , Department of Medicine, Division of Cardiology, Assistant Professor, Division Pediatric Cardiology, Director, Pediatric Electrophysiology Service, Department of Pediatrics, Division of Pediatric Cardiology, Mount Sinai School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD Emeritus Professor of Pediatrics, University of Pennsylvania School of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

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Echocardiographic image of a 1-month-old infant with a large isolated aortopulmonary septal defect (APSD). The image is a parasternal short-axis view just below the pulmonary artery bifurcation. Aorta at this level is to the right and in the same anterior-posterior plane as the main pulmonary artery (MPA). Right pulmonary artery is seen posterior to the aorta at this level, but the origin of the pulmonary arteries is not visible; it is more superior than this axial image. Normally, a complete wall should be visible for both aorta and pulmonary artery. This image shows the absence of that wall, resulting in the large defect between aorta and pulmonary artery.
Angiogram of a small-to-moderate aortopulmonary septal defect in a 4 year-old child. Complete occlusion of the aortopulmonary septal defect with an Amplatzer Duct Occluder. Ao = Ascending aorta; PA = Pulmonary artery.
 
 
 
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