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Pediatric Valvar Aortic Stenosis Medication

  • Author: Howard S Weber, MD, FSCAI; Chief Editor: Steven R Neish, MD, SM  more...
 
Updated: Aug 19, 2015
 

Medication Summary

Treatment with prostaglandin E1 is necessary for neonates with critical aortic stenosis and low cardiac output. This agent establishes patency of the ductus arteriosus and can restore adequate systemic blood flow and the perfusion of vital organs.

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Prostaglandins

Class Summary

Prostaglandin E1 is used for the treatment of ductal-dependent, cyanotic congenital heart disease caused by decreased pulmonary blood flow. Patients with critical aortic stenosis and low cardiac output require resuscitation with prostaglandin E1. Establishing the patency of the ductus arteriosus can restore systemic blood flow and the perfusion of vital organs.

Alprostadil is a first-line palliative therapy to temporarily maintain patency of the ductus arteriosus before surgery. It produces vasodilation and increases cardiac output. Each 1 mL ampule contains 500 mcg/mL.

Alprostadil IV (Prostin VR Pediatric Injection)

 

This drug is effective in relaxing the smooth muscle of the ductus arteriosus. It is beneficial in infants with congenital defects that restrict pulmonary or systemic blood flow and who depend on a patent ductus arteriosus to get adequate oxygenation and lower body perfusion.

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Inotropic Agents

Class Summary

Inotropic drugs, such as dopamine, dobutamine, and epinephrine, are indicated in cases of reduced cardiac output in aortic stenosis.

Dopamine

 

Dopamine is a naturally occurring endogenous catecholamine that stimulates beta1 and alpha1 adrenergic and dopaminergic receptors in a dose-dependent fashion; it stimulates the release of norepinephrine.

Dobutamine

 

Dobutamine produces vasodilation and increases the inotropic state. At higher dosages, it may cause an increased heart rate, exacerbating myocardial ischemia.

Epinephrine (Adrenalin)

 

Epinephrine has alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta2-agonist effects include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.

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Loop Diuretics

Class Summary

Loop diuretics such as intravenous furosemide may be used carefully in pediatric patients with reduced cardiac function and/or significant mitral valve insufficiency when associated with severe aortic valve stenosis. The benefit is to reduce pulmonary venous congestion secondary to elevated left atrial pressures.

Furosemide (Lasix)

 

Furosemide is a loop diuretic that increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. It increases renal blood flow without increasing the filtration rate. It increases potassium, sodium, calcium, and magnesium excretion.

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Contributor Information and Disclosures
Author

Howard S Weber, MD, FSCAI Professor of Pediatrics, Section of Pediatric Cardiology, Pennsylvania State University College of Medicine; Director of Interventional Pediatric Cardiology, Penn State Hershey Children's Hospital

Howard S Weber, MD, FSCAI is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions

Disclosure: Received income in an amount equal to or greater than $250 from: St. Jude Medical.

Coauthor(s)

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.

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.

John W Moore, MD, MPH Professor of Clinical Pediatrics, Section of Pediatic Cardiology, Department of Pediatrics, University of California San Diego School of Medicine; Director of Cardiology, Rady Children's Hospital

John W Moore, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions

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, American Heart Association

Disclosure: Nothing to disclose.

Additional Contributors

Juan Carlos Alejos, MD Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, International Society for Heart and Lung Transplantation

Disclosure: Received honoraria from Actelion for speaking and teaching.

References
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