Supracristal Ventricular Septal Defect Medication

  • Author: Ira H Gessner, MD; Chief Editor: Stuart Berger, MD   more...
 
Updated: Nov 15, 2011
 

Medication Summary

For patients who develop aortic valve insufficiency, surgical closure of the ventricular septal defect (VSD) and repair of valve insufficiency is the preferred treatment. If surgical repair must be postponed, afterload reducers, such as angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers, have proved helpful in adults and children.[22] ACE inhibitors that may be employed include enalapril, lisinopril, and captopril. Nifedipine is an effective calcium channel blocker.

Next

Angiotensin Converting Enzyme (ACE) Inhibitors

Class Summary

These agents have proved beneficial in long-term therapy for aortic valve insufficiency. Positive effects include reductions in pulse pressure, regurgitant volume, left ventricular volume, and left ventricular mass (because of beneficial effects on ventricular remodeling).

View full drug information

Enalapril (Vasotec)

 

Enalapril is considered a reasonable first drug of choice in this group because of its increased dosing interval (q12-24h). A competitive ACE inhibitor, it reduces angiotensin II levels, decreasing aldosterone secretion. Enalapril is available in a liquid suspension.

View full drug information

Lisinopril (Prinivil, Zestril)

 

Lisinopril is considered a reasonable first drug of choice in this group because of its increased dosing interval (q12-24h). It prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

View full drug information

Captopril

 

Captopril prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion. For younger children or infants, this agent can be formulated as a suspension if it is stabilized with ascorbic acid to prevent hydrolysis. The dosing interval is 6-8 hours because of captopril's shorter half-life.

Previous
Next

Calcium Channel Blockers

Class Summary

Calcium channel blockers also have proved effective in reducing afterload and lowering pulse pressure and regurgitant volume. Prolonged, regular use may stabilize left ventricular volume, but the effect on left ventricular muscle mass is less pronounced than that of ACE inhibitors.

View full drug information

Nifedipine (Adalat, Procardia, Afeditab CR, Nifedical XL)

 

Nifedipine is a good first choice because of its primary action on peripheral resistance and its limited effect on cardiac function and heart rate.

View full drug information

Diltiazem (Cardizem, Dilacor XR, Diltzac, Matzim LA)

 

During depolarization, diltiazem inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.

Previous
 
Contributor Information and Disclosures
Author

Ira H Gessner, MD  Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Edward J Bayne, MD  Assistant Professor, Division of Pediatric Cardiology, Emory University School of Medicine; Consulting Staff, Sibley Heart Center Cardiology, Children's Healthcare of Atlanta

Edward J Bayne, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, and American Society of Echocardiography

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.

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, and International Society for Heart and Lung Transplantation

Disclosure: Actelion Honoraria Speaking and teaching

Hugh D Allen, MD Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

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.

References

  1. McDaniel NL, Gutgesell HP. Ventricular septal defects. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF. Moss and Adams' Heart Disease in Infants, Children, and Adolescents. 7th ed. Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins; 2008:667-682.

  2. 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].

  3. Anderson RH, Wilcox BR. The surgical anatomy of ventricular septal defects associated with overriding valvar orifices. J Card Surg. Mar 1993;8(2):130-42. [Medline].

  4. Cheung YF, Chiu CS, Yung TC. Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect. Ann Thorac Surg. Feb 2002;73(2):622-7. [Medline].

  5. Ho SY, Baker EJ, Rigby ML. Color Atlas of Congenital Heart Disease: Morphologic and Clinical Correlations. St Louis, MO: Mosby-Wolfe; 1995.

  6. Eroglu AG, Oztunc F, Saltik L, et al. Evolution of ventricular septal defect with special reference to spontaneous closure rate, subaortic ridge and aortic valve prolapse. Pediatr Cardiol. Jan-Feb 2003;24(1):31-5. [Medline].

  7. Mori K, Matsuoka S, Tatara K, et al. Echocardiographic evaluation of the development of aortic valve prolapse in supracristal ventricular septal defect. Eur J Pediatr. Mar 1995;154(3):176-81. [Medline].

  8. Gittenberger-De Groot AC, Poelmann RE. Normal and abnormal cardiac development. In: Moller JH, Hoffman JI, eds. Pediatric Cardiovascular Medicine. New York, NY: Churchill Livingstone; 2000:3-20.

  9. Boot MJ, Steegers-Theunissen RP, Poelmann RE, van Iperen L, Gittenberger-de Groot AC. Cardiac outflow tract malformations in chick embryos exposed to homocysteine. Cardiovasc Res. Nov 1 2004;64(2):365-73. [Medline].

  10. Momma K, Ando M, Matsuoka R, Joo K. Interruption of the aortic arch associated with deletion of chromosome 22q11 is associated with a subarterial and doubly committed ventricular septal defect in Japanese patients. Cardiol Young. Sep 1999;9(5):463-7. [Medline].

  11. Leung MP, Beerman LB, Siewers RD, et al. Long-term follow-up after aortic valvuloplasty and defect closure in ventricular septal defect with aortic regurgitation. Am J Cardiol. Oct 1 1987;60(10):890-4. [Medline].

  12. Rhodes LA, Keane JF, Keane JP, et al. Long follow-up (to 43 years) of ventricular septal defect with audible aortic regurgitation. Am J Cardiol. Aug 1 1990;66(3):340-5. [Medline].

  13. Elgamal MA, Hakimi M, Lyons JM, Walters HL III. Risk factors for failure of aortic valvuloplasty in aortic insufficiency with ventricular septal defect. Ann Thorac Surg. Oct 1999;68(4):1350-5. [Medline].

  14. Zuberbuhler JR. Ventricular septal defect. In: Clinical Diagnosis in Pediatric Cardiology. London, England: Churchill Livingstone; 1981:39-45.

  15. Cheng TO, Xie MX, Wang XF, Wang Y, Lu Q. Real-time 3-dimensional echocardiography in assessing atrial and ventricular septal defects: an echocardiographic-surgical correlative study. Am Heart J. Dec 2004;148(6):1091-5. [Medline].

  16. Masaki N, Iwatsuka R, Nagahori W, et al. Three-dimensional echocardiography could distinguish a ventricular septal defect adjacent to asymptomatic ruptured sinus of valsalva aneurysm. J Cardiol. Apr 2008;51(2):139-43. [Medline].

  17. Freedom RM, Mawson JB, Yoo SJ. Ventricular septal defect. In: Freedom RM, et al, eds. Congenital Heart Disease: Textbook of Angiocardiography. Futura Publishing Co; 1997:189-218.

  18. Wang ZJ, Reddy GP, Gotway MB, et al. Cardiovascular shunts: MR imaging evaluation. Radiographics. Oct 2003;23 Spec No:S181-94. [Medline]. [Full Text].

  19. Yacoub MH, Khan H, Stavri G, et al. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of Valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg. Feb 1997;113(2):253-60; discussion 261. [Medline].

  20. Komai H, Naito Y, Fujiwara K, Noguchi Y, Nishimura Y, Uemura S. Surgical strategy for doubly committed subarterial ventricular septal defect with aortic cusp prolapse. Ann Thorac Surg. Oct 1997;64(4):1146-9. [Medline].

  21. Leung MP, Chau KT, Chiu C, Yung TC, Mok CK. Intraoperative TEE assessment of ventricular septal defect with aortic regurgitation. Ann Thorac Surg. Mar 1996;61(3):854-60. [Medline].

  22. Levine HJ, Gaasch WH. Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves. J Am Coll Cardiol. Nov 1 1996;28(5):1083-91. [Medline].

 
Previous
Next
 
Parasternal long-axis echocardiogram view showing supracristal ventricular septal defect (arrow) with buckling and prolapse (***) of the right coronary leaflet of the aortic valve.
Parasternal short-axis echocardiogram view with color Doppler showing proximity of ventricular septal defect jet to the aortic and pulmonic valves. The patient is an infant with neither aortic valve prolapse nor aortic insufficiency.
Subcostal "right ventricular inflow/outflow" view showing the close relationship between the aortic and pulmonic valves in the presence of supracristal ventricular septal defect. Turbulent shunt flow is shown directed into the main pulmonary artery. The patient is an infant with neither aortic valve prolapse nor insufficiency.
Transesophageal horizontal view of aortic root and right ventricle, showing sinus of Valsalva aneurysm leaking through a supracristal ventricular septal defect (VSD)(>
 
 
 
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.