Supracristal Ventricular Septal Defect Medication
- Author: Ira H Gessner, MD; Chief Editor: Howard S Weber, MD, FSCAI more...
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, diuretics and afterload reducers, such as angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers, have proved helpful in adults and children. ACE inhibitors that may be employed include enalapril, lisinopril, and captopril. Nifedipine is an effective calcium channel blocker.
Angiotensin Converting Enzyme (ACE) Inhibitors
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).
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.
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.
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.
Calcium Channel Blockers
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.
Nifedipine is a good first choice because of its primary action on peripheral resistance and its limited effect on cardiac function and heart rate.
During depolarization, diltiazem inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.
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