Medication Summary

Asymptomatic patients with ostium primum atrial septal defects (ASDs) do not require medications. Those with evidence of congestive heart failure (CHF) warrant diuresis, traditionally using furosemide. Afterload reduction with an angiotensin-converting enzyme (ACE) inhibitor may also be prudent and may aid in the management of mitral regurgitation. Digitalis was previously thought to improve CHF by improving cardiac output and by increasing renal blood flow, with effects primarily related to an increase in cardiac contractility. However, its use for the management of CHF has generally fallen out of favor.

In 2007, the American Heart association (AHA) guidelines changed its recommendations to no longer warrant preoperative subacute bacterial endocarditis prophylaxis^{[22, 23, 24]}; however, antibiotics for endocarditis prophylaxis are required for 6 months postoperatively.^{[22, 23]}Patients with persistent atrioventricular (AV) valve abnormalities and/or significant mitral regurgitation adjacent to suture or patch material may require long-term prophylaxis before undergoing procedures that may cause bacteremia.

Class Summary

These agents are used to relieve volume overload and pulmonary congestion in patients with CHF.

Furosemide (Lasix)

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Loop diuretic, acting on the thick ascending limb of the loop of Henle. It increases renal blood flow without increasing filtration rate. Its onset of action generally is within 1 h. Potassium, sodium, calcium, and magnesium excretion is increased. Titratable acid and ammonium excretion also are increased, which, in combination with a contraction of extracellular fluid volume, results in a metabolic alkalosis.

Class Summary

The primary indication for ACE inhibition for CHF and/or significant mitral regurgitation is to decrease afterload. These drugs cause a decrease in blood pressure with a concomitant decrease in systemic arteriolar resistance. Cardiac output, cardiac index, stroke volume, and stroke work increase, and the heart rate generally decreases. At the same time, renal blood flow increases and aldosterone secretion decreases, resulting in a beneficial natriuresis.

Captopril (Capoten)

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Rapidly absorbed, but bioavailability is significantly reduced with food intake. It achieves a peak concentration in an hour and has a short half-life. The drug is cleared by the kidney. Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

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Media Gallery

Electrocardiogram from a patient with a partial atrioventricular septal defect. The PR interval is mildly prolonged. Left axis deviation with Q waves in leads I and aVL are present, consistent with a counterclockwise loop in the frontal plane. Right atrial enlargement and an rsR' pattern in the right chest leads are also noted.
Two-dimensional, apical, four-chamber echocardiogram of a partial atrioventricular (AV) septal defect. The asterisk (*) delineates an area of dropout in the inferior atrial septum at the site of the primum atrial septal defect. The AV valves are separate but aligned at the same horizontal level, consistent with a two-orifice common AV valve. In systole, the medial leaflets of the right- and left-sided AV valves demonstrate attachments to the crest of the interventricular septum, allowing no ventricular level shunting. LA = left atrium, LV = left ventricle, RA = right atrium, and RV = right ventricle.
Gross pathology specimen viewed from the opened left atrium and left ventricle, demonstrating a partial atrioventricular (AV) septal defect. An ostium primum atrial septal defect (ASD) marked by an asterisk (*) is visualized in the inferior aspect of the interatrial septum. An ostium secundum ASD marked by two asterisks (**) is also noted. The mitral valve is cleft and the leaflets are thickened and rolled, suggestive of chronic mitral regurgitation. LA = left atrium, LV = left ventricle, and MV = mitral valve.