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Double Orifice Mitral Valve Medication

  • Author: Georgios A Hartas, MD; Chief Editor: Stuart Berger, MD  more...
 
Updated: Mar 19, 2014
 

Medication Summary

Medical therapy for double orifice mitral valve (DOMV) consists of the use of drugs to control of congestive heart failure (CHF). The 3 groups of drugs used are diuretics (to promote excretion of excess water), positive inotropic drugs (to improve myocardial contraction), and vasodilators (to reduce arterial resistance).

Antibiotics for endocarditis prophylaxis are administered to patients before procedures that may cause bacteremia are performed. For more information, see Antibiotic Prophylactic Regimens for Endocarditis.

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Diuretics

Class Summary

These drugs promote the excretion of water and electrolytes by the kidneys and are used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention results in edema or ascites. They are useful to remove excess water that accumulates in patients with CHF. They also relieve symptoms associated with pulmonary congestion and reduce peripheral edema.

Furosemide (Lasix)

 

Drug of choice (DOC) for rapid relief of pulmonary congestion and edema from heart failure. Useful for maintenance therapy of CHF in patients with DOMV. Promotes renal excretion of water by inhibiting electrolyte-transport system in ascending limb of loop of Henle. Increases solute and water excretion, even with declining glomerular filtration rate.

Chlorothiazide (Diuril)

 

Increases water excretion by inhibiting reabsorption of sodium chloride in distal renal tubule. Less potent than furosemide, thiazide diuretics useful in maintenance therapy of CHF; in severe heart failure or refractory edema, act synergistically with furosemide to promote diuresis.

Hydrochlorothiazide (Esidrix, HydroDIURIL)

 

Increases water excretion by inhibiting reabsorption of sodium chloride in distal renal tubule. Less potent than furosemide. Useful in maintenance therapy of CHF; in severe heart failure or refractory edema, act synergistically with furosemide to promote diuresis.

Spironolactone (Aldactone)

 

Counteracts secondary hyperaldosteronism in cardiac failure. Inhibits sodium absorption in collecting duct. Potassium-sparing diuretic effect. Used alone, produces relatively mild diuresis. Can be used with furosemide for synergistic action in severe CHF.

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Inotropic agents

Class Summary

Positive inotropic agents increase the force of myocardial contraction and are used to treat acute and chronic CHF. Some may also provide vasodilatation, improve myocardial relaxation, or increase or decrease the heart rate (positive or negative chronotropic agents, respectively). These additional properties influence the choice of drug for specific circumstances.

Digoxin (Lanoxin)

 

DOC to improve cardiac failure because of positive inotropic effect on myocardium. Helps control fast ventricular rate, especially in atrial arrhythmia.

Common preparations in children include tabs 0.125 or 0.25 mg and elixir 0.05 mg/mL. Caps and parenteral injection also available.

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Vasodilators

Class Summary

Drugs that produce vasodilation include ACE inhibitors, nitrates, and direct vasodilators (eg, hydralazine). Of these drug classes, ACE inhibitors are frequently used because their adverse effects are the most tolerated. They reduce afterload on the LV by decreasing systemic arterial resistance. ACE inhibitors are particularly helpful in patients with mitral regurgitation, in whom decreased afterload reduces the severity of regurgitation and improves ventricular function. The DOC is captopril. Newer drugs from this category, such as enalapril and lisinopril, are also used for the treatment of CHF, but experience with their use in children is limited.

Captopril (Capoten)

 

Prevents conversion of angiotensin I to angiotensin II, potent vasoconstrictor. Lowers vascular resistance and aldosterone secretion.

Enalapril (Vasotec)

 

Competitive ACE inhibitor. Reduces angiotensin II level, potent vasoconstrictor. Lowers vascular resistance and aldosterone secretion.

Lisinopril (Zestril, Prinivil)

 

Prevents conversion of angiotensin I to angiotensin II, potent vasoconstrictor. Lowers vascular resistance and aldosterone secretion.

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Contributor Information and Disclosures
Author

Georgios A Hartas, MD Pediatric Interventional Cardiologist, The Children's Heart Institute

Georgios A Hartas, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Texas Medical Association, Texas Pediatric Society, Harris County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

P Syamasundar Rao, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

P Syamasundar Rao, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Duraisamy Balaguru, MBBS MRCP, FACC, FAAP, FSCAI, Associate Professor of Pediatrics, Division of Pediatric Cardiology, University of Texas Medical School at Houston; Attending Physician, Division of Pediatric Cardiology, Children’s Memorial Hermann Hospital

Duraisamy Balaguru, MBBS is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, American Stroke Association, Pediatric Cardiac Intensive Care Society, International Society of Invasive Cardiology in Congenital Heart Disease, World Society for Pediatric and Congenital Heart Surgery

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.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received grant/research funds from Lundbeck Pharmaceuticals for none.

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

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.

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Two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
Two-dimensional echocardiogram (parasternal short-axis view) shows double-orifice mitral valve, the orifice being divided by a bridge of tissue.
Two-dimensional echocardiogram of a double-orifice mitral valve (apical view) with color flow mapping, which shows diastolic flow through 2 separate orifices.
Two-dimensional echocardiogram (parasternal short-axis view) in a patient with duplicate mitral valve. This diastolic frame shows two typical mitral valve orifices opening into the left ventricle. The two orifices are placed apart unlike the more common type of double-orifice mitral valve (see image above) where the orifice is divided by a bridge of tissue.
Real-time two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
Real-time two-dimensional echocardiogram (subcostal short-axis view) in a patient with duplicate mitral valve showing two typical mitral valves opening into the left ventricle. The two orifices are placed apart unlike the more common type of double-orifice mitral valve (see image above) where the orifice is divided by a bridge of tissue.
 
 
 
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