Sections

Pediatric Mitral Valve Prolapse

Sections Pediatric Mitral Valve Prolapse
Overview
Presentation
DDx
Workup
Treatment
Medication
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References

Medication

Medication Summary

Medical strategies for mitral valve prolapse (MVP) include the following:

Anticongestive heart failure therapy
Antibiotic therapy for endocarditis prophylaxis during surgery, dental, and genitourinary procedures: Only necessary if associated mitral regurgitation is present (See Antibiotic Prophylactic Regimens for Endocarditis.)^[18]
Antiarrhythmic therapy: May be indicated in patients with documented and/or symptomatic arrhythmia, depending on findings of noninvasive and/or invasive electrophysiologic testing
Beta-blockers (eg, propranolol): May be beneficial for symptom prevention, reduction in ectopy, treatment of vasodepressor syncope, panic attacks, or antiarrhythmic therapy^[25]
Antiplatelet therapy (eg, aspirin, dipyridamole): Used in patients with thromboembolic episodes
Angiotensin-converting enzymne (ACE) inhibitors:- Used in patients with significant mitral regurgitation
Low-dose aspirin and/or anticoagulant therapy (eg, warfarin): Considered in patients with thromboembolic episodes

Class Summary

These agents block the beta-adrenergic receptor and are modulators of the autonomic system. They inhibit chronotropic, inotropic and vasodilatory responses to beta-adrenergic stimulation.

Propranolol (Inderal)

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Inhibits beta1-adrenergic and beta2-adrenergic receptors. Class II antiarrhythmic, nonselective, beta-adrenergic receptor blocker with membrane-stabilizing activity that decreases automaticity of contractions.

Class Summary

These drugs are used for secondary prevention of thrombotic cerebrovascular or cardiac disease.

Aspirin (Anacin, Bayer, Empirin)

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Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.

Dipyridamole (Persantine)

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Acts by decreasing platelet aggregation. Inhibits thrombus formation in the arterial side of circulation.

Class Summary

These drugs are used to release retained fluid and lower preload.

Furosemide (Lasix)

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Inhibits reabsorption of fluid from ascending limb of the Henle loop in renal tubule. Administered IV. Has venodilation action; thus, also lowers preload even before diuresis effect. Useful in acute heart failure and exacerbations of chronic heart failure.

Spironolactone (Aldactone)

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Potassium-sparing diuretic. Acts on the distal convoluted tubule of the kidney as an aldosterone antagonist. Has synergistic action with furosemide.

Amiloride (Midamor)

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Pyrazine-carbonyl-guanidine unrelated chemically to other known antikaliuretic or diuretic agents. Potassium-conserving (antikaliuretic) drug that, compared with thiazide diuretics, possesses weak natriuretic, diuretic, and antihypertensive activity. Acts directly on the distal renal tubule, usually used along with a potassium-losing diuretic.

Class Summary

These agents reduce afterload and decrease myocardial remodeling, which worsens chronic heart failure.

Captopril (Capoten)

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Accepted as essential part of heart failure therapy. Not only gives symptomatic improvement but also prolongs survival.

Class Summary

These agents provide symptomatic improvement in heart failure.

Digoxin (Lanoxin)

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Improves myocardial contractility, reduces heart rate, and lowers sympathetic stimulation in chronic heart failure.

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Media Gallery

Chest radiograph of 5-year-old girl with mitral valve prolapse (MVP) and mild mitral regurgitation. The radiograph shows cardiomegaly and normal pulmonary vasculature.
Two-lead electrocardiogram of a child with mitral valve prolapse (MVP) showing T-Wave inversion in leads III and aVF.
Two-dimensional echocardiographic picture taken from the parasternal long-axis view showing prolapse of both anterior and posterior mitral valve leaflets into the left atrium at systole.
Color-Doppler echocardiography of a child with mitral valve prolapse showing jet of mitral regurgitation.
M-mode echocardiographic picture of mitral valve prolapse showing pansystolic prolapse of both anterior and posterior mitral leaflets toward left atrium.
Plain radiograph of the left hand of a 10-year-old boy with marfanoid syndrome and mitral valve prolapse (MVP) showing the long thin metacarpals. The metacarpal index is longer than normal.

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Author

Poothirikovil Venugopalan, MBBS, MD, FRCPCH Consultant Pediatrician with Cardiology Expertise, Department of Child Health, Brighton and Sussex University Hospitals, NHS Trust; Honorary Senior Clinical Lecturer, Brighton and Sussex Medical School, UK

Poothirikovil Venugopalan, MBBS, MD, FRCPCH is a member of the following medical societies: British Congenital Cardiac Association, Paediatrician with Cardiology Expertise Special Interest Group, Royal College of Paediatrics and Child Health

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 research grant from: Lundbeck Pharmaceuticals<br/>Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

Syamasundar Rao Patnana, 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

Syamasundar Rao Patnana, 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.

Additional Contributors

Charles I Berul, MD Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Sections Pediatric Mitral Valve Prolapse
Overview
Presentation
DDx
Workup
Treatment
Medication
Media Gallery
References

Pediatric Mitral Valve Prolapse Medication

Medication Summary

Beta-adrenergic blocking agents

Class Summary

Propranolol (Inderal)

Propranolol (Inderal)

Antiplatelet agents

Class Summary

Aspirin (Anacin, Bayer, Empirin)

Aspirin (Anacin, Bayer, Empirin)

Dipyridamole (Persantine)

Dipyridamole (Persantine)

Diuretics

Class Summary

Furosemide (Lasix)

Furosemide (Lasix)

Spironolactone (Aldactone)

Spironolactone (Aldactone)

Amiloride (Midamor)

Amiloride (Midamor)

ACE inhibitors

Class Summary

Captopril (Capoten)

Captopril (Capoten)

Cardiac glycoside

Class Summary

Digoxin (Lanoxin)

Digoxin (Lanoxin)

Pediatric Mitral Valve Prolapse Medication

Medication Summary

Beta-adrenergic blocking agents

Class Summary

Propranolol (Inderal)

Antiplatelet agents

Class Summary

Aspirin (Anacin, Bayer, Empirin)

Dipyridamole (Persantine)

Diuretics

Class Summary

Furosemide (Lasix)

Spironolactone (Aldactone)

Amiloride (Midamor)

ACE inhibitors

Class Summary

Captopril (Capoten)

Cardiac glycoside

Class Summary

Digoxin (Lanoxin)

References

Tables

Contributor Information and Disclosures

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