Aortopulmonary Septal Defect Medication

  • Author: Barry A Love, MD; Chief Editor: Stuart Berger, MD   more...
 
Updated: Mar 5, 2012
 

Medication Summary

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

Next

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.

View full drug information

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.

Previous
Next

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.

View full drug information

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.

View full drug information

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.

View full drug information

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.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

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

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; Editor-in-Chief, Medscape Drug Reference

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

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital 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, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. Bohuta L, Hussein A, Fricke TA, d'Udekem Y, Bennett M, Brizard C, et al. Surgical repair of truncus arteriosus associated with interrupted aortic arch: long-term outcomes. Ann Thorac Surg. May 2011;91(5):1473-7. [Medline].

  2. Kutsche LM, Van Mierop LH. Anatomy and pathogenesis of aorticopulmonary septal defect. Am J Cardiol. Feb 15 1987;59(5):443-7. [Medline].

  3. Mert M, Paker T, Akcevin A, et al. Diagnosis, management, and results of treatment for aortopulmonary window. Cardiol Young. Oct 2004;14(5):506-11. [Medline].

  4. Dipchand AI, Giuffre M, Freedom RM. Tetralogy of Fallot with non-confluent pulmonary arteries and aortopulmonary septal defect. Cardiol Young. Jan 1999;9(1):75-7. [Medline].

  5. Erez E, Dagan O, Georghiou GP, et al. Surgical management of aortopulmonary window and associated lesions. Ann Thorac Surg. Feb 2004;77(2):484-7. [Medline].

  6. Murin P, Sinzobahamvya N, Blaschczok HC, Photiadis J, Haun C, Asfour B, et al. Aortopulmonary Window Associated with Interrupted Aortic Arch: Report of Surgical Repair of Eight Cases and Review of Literature. Thorac Cardiovasc Surg. Jan 17 2012;[Medline].

  7. Carminati M, Borghi A, Valsecchi O, et al. Aortopulmonary window coexisting with tetralogy of Fallot: echocardiographic diagnosis. Pediatr Cardiol. Jan 1990;11(1):41-3. [Medline].

  8. Antonetti I, Lorch D, Coe B, Maxey TS, Nallamshetty L, Dadlani GH, et al. Unrepaired Tetralogy of Fallot with Major Aortopulmonary Collateral Arteries in an Adult Patient. Congenit Heart Dis. Dec 18 2011;[Medline].

  9. Marangi D, Peterson RJ, Ceithaml EL, Marvin WJ Jr. Surgical repair of d-transposition with aortopulmonary window: a case report. J Thorac Cardiovasc Surg. Mar 1996;111(3):671-2. [Medline].

  10. Bajpai P, Shah S, Misri A, Rao S, Suresh P, Maheshwari S. Assessment of operability in d-transposition of great arteries with ventricular septal defect: A practical method. Ann Pediatr Cardiol. Jan 2011;4(1):41-4. [Medline]. [Full Text].

  11. Nelson AW. Aorticopulmonary window in a dog. J Am Vet Med Assoc. May 1 1986;188(9):1055-8. [Medline].

  12. Kiran VS, Singh MK, Shah S, John C, Maheshwari S. Lessons learned from a series of patients with missed aortopulmonary windows. Cardiol Young. Oct 2008;18(5):480-4. [Medline].

  13. Valsangiacomo ER, Smallhorn JF. Images in cardiovascular medicine. Prenatal diagnosis of aortopulmonary window by fetal echocardiography. Circulation. Jun 18 2002;105(24):E192. [Medline].

  14. Alvarez R, García-Díaz L, Coserria F, Hosseinpour R, Antiñolo G. Aortopulmonary window with atrial septal defect: prenatal diagnosis, management and outcome. Fetal Diagn Ther. 2011;30(4):306-8. [Medline].

  15. Waters BL, Allen EF, Gibson PC, Johnston T. Autopsy findings in a severely affected infant with a 2q terminal deletion. Am J Med Genet. Nov 15 1993;47(7):1099-103. [Medline].

  16. Bergstrom CS, Saunders RA, Hutchinson AK, Lambert SR. Iris hypoplasia and aorticopulmonary septal defect: a neurocristopathy. J AAPOS. Jun 2005;9(3):264-7. [Medline].

  17. Balaji S, Burch M, Sullivan ID. Accuracy of cross-sectional echocardiography in diagnosis of aortopulmonary window. Am J Cardiol. Mar 15 1991;67(7):650-3. [Medline].

  18. Horimi H, Hasegawa T, Shiraishi H, et al. Detection of aortopulmonary window with ventricular septal defect by Doppler color flow imaging. Chest. Jan 1992;101(1):280-1. [Medline].

  19. Garver KA, Hernandez RJ, Vermilion RP, Goble M. Images in cardiovascular medicine. Correlative imaging of aortopulmonary window: demonstration with echocardiography, angiography, and MRI. Circulation. Aug 5 1997;96(3):1036-7. [Medline].

  20. Singh A, Mehmood F, Romp RL, Nanda NC, Mallavarapu RK. Live/Real time three-dimensional transthoracic echocardiographic assessment of aortopulmonary window. Echocardiography. Jan 2008;25(1):96-9. [Medline].

  21. Stamato T, Benson LN, Smallhorn JF, Freedom RM. Transcatheter closure of an aortopulmonary window with a modified double umbrella occluder system. Cathet Cardiovasc Diagn. Jun 1995;35(2):165-7. [Medline].

  22. Naik GD, Chandra VS, Shenoy A, et al. Transcatheter closure of aortopulmonary window using Amplatzer device. Catheter Cardiovasc Interv. Jul 2003;59(3):402-5. [Medline].

  23. Trehan V, Nigam A, Tyagi S. Percutaneous closure of nonrestrictive aortopulmonary window in three infants. Catheter Cardiovasc Interv. Feb 15 2008;71(3):405-11. [Medline].

  24. Backer CL, Mavroudis C. Surgical management of aortopulmonary window: a 40-year experience. Eur J Cardiothorac Surg. May 2002;21(5):773-9. [Medline].

  25. Di Bella I, Gladstone DJ. Surgical management of aortopulmonary window. Ann Thorac Surg. Mar 1998;65(3):768-70. [Medline].

  26. Hew CC, Bacha EA, Zurakowski D, et al. Optimal surgical approach for repair of aortopulmonary window. Cardiol Young. Jul 2001;11(4):385-90. [Medline].

  27. Prasad TR, Valiathan MS, Shyamakrishnan KG, Venkitachalam CG. Surgical management of aortopulmonary septal defect. Ann Thorac Surg. Jun 1989;47(6):877-9. [Medline].

  28. Tkebuchava T, von Segesser LK, Vogt PR, et al. Congenital aortopulmonary window: diagnosis, surgical technique and long-term results. Eur J Cardiothorac Surg. Feb 1997;11(2):293-7. [Medline].

  29. Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. Aug 19 2008;118(8):887-96. [Medline]. [Full Text].

  30. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Oct 9 2007;116(15):1736-54. [Medline]. [Full Text].

  31. Chopra PS, Reed WH, Wilson AD, Rao PS. Delayed presentation of anomalous circumflex coronary artery arising from pulmonary artery following repair of aortopulmonary window in infancy. Chest. Dec 1994;106(6):1920-2. [Medline].

  32. Grunenfelder J, Zund G, Vogt PR, Turina MI. Aortopulmonary window with anomalous origin of the right coronary artery. Ann Thorac Surg. Jan 1999;67(1):233-5. [Medline].

  33. Izumoto H, Ishihara K, Fujii Y, et al. AP Window and Anomalous Origin of the Right Coronary Artery From the Window. Annals of Thoracic Surgery. 1999;68:557-9. [Medline].

  34. McElhinney DB, Reddy VM, Tworetzky W, et al. Early and late results after repair of aortopulmonary septal defect and associated anomalies in infants < 6 months of age. Am J Cardiol. Jan 15 1998;81(2):195-201. [Medline].

  35. Tulloh RM, Rigby ML. Transcatheter umbrella closure of aorto-pulmonary window. Heart. May 1997;77(5):479-80. [Medline].

  36. van Son JA, Puga FJ, Danielson GK, et al. Aortopulmonary window: factors associated with early and late success after surgical treatment. Mayo Clin Proc. Feb 1993;68(2):128-33. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.