Valvar Pulmonary Stenosis Medication

Updated: Jun 26, 2014
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Medication

Medication Summary

No medications are useful in isolated valvar pulmonary stenosis. Patients with congestive heart failure (CHF) may benefit from anticongestive therapy. Patients with cyanosis may benefit from oxygen and prostaglandin E1. Patients with cyanosis due to a large right-to-left shunt require a definitive surgical procedure.

Patients with certain cardiac conditions, such as pulmonary stenosis, typically require antibiotic prophylaxis for endocarditis before they undergo procedures that may cause bacteremia. For more information, see Antibiotic Prophylactic Regimens for Endocarditis.

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Prostaglandins

Class Summary

Alprostadil (Prostaglandin E1, PGE1) is used to treat ductal-dependent cyanotic congenital heart disease, which is caused by decreased pulmonary blood flow. Alprostadil acts as a smooth muscle relaxer and maintains patency of the ductus arteriosus when a cyanotic lesion (eg, critical pulmonary stenosis or atresia) or when an interrupted aortic arch occurs in a newborn. This drug is effective only in the neonatal period.

Alprostadil IV (Prostin VR)

First-line drug used as palliative therapy to temporarily maintain patency of ductus arteriosus before surgery. Produces vasodilation and increases cardiac output. Also inhibits platelet aggregation and stimulates intestinal and uterine smooth muscle.

Used in suspected critical pulmonary stenosis when presentation includes cyanosis. Also used in ductal-dependent lesion (eg, pulmonary atresia variants, coarctation of aorta, interrupted aortic arch). Each 1-mL ampule contains 500 mcg/mL.

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Beta-blockers

Class Summary

These drugs inhibit chronotropic, inotropic, and vasodilatory responses to beta-adrenergic stimulation.

Atenolol (Tenormin)

Used to treat hypertension. Selectively blocks beta1-receptors with little or no affect on beta2 types. Beta-blockers affect BP by several mechanisms, including negative chronotropic effect that decreases heart rate at rest and after exercise, negative inotropic effect that decreases cardiac output, reduction of sympathetic outflow from the CNS, and suppression of renin release from the kidneys. Used to improve and preserve hemodynamic status by acting on myocardial contractility to reduce congestion and decrease myocardial energy expenditure.

Beta-blockers reduce inotropic state of left ventricle, improve diastolic function, and increase LV compliance, reducing pressure gradient across LV outflow tract. Decreases myocardial oxygen consumption, reducing myocardial ischemia potential. Decreases heart rate, reducing myocardial oxygen consumption and reducing potential for myocardial ischemia. During IV administration, carefully monitor BP, heart rate, and ECG.

The drug may be used to reduce hypercontractility of the right ventricle in patients with significant infundibular stenosis (gradients >50 mm Hg) following balloon pulmonary valvuloplasty.

Esmolol (Brevibloc)

Ultra–short-acting that selectively blocks beta1-receptors with little or no effect on beta2-receptors. Particularly useful in elevated arterial pressure, especially if surgery planned. Reduced episodes of chest pain and clinical cardiac events compared with placebo. Can discontinue abruptly if necessary. Useful in patients at risk for complications from beta-blockade, particularly those with reactive airway disease, mild-to-moderate LV dysfunction, and/or peripheral vascular disease. Short half-life of 8 min allows for titration to desired effect and quick discontinuation if needed.

Propranolol (Inderal)

Nonselective beta-blocker. Lipophilic (penetrates CNS). Has membrane-stabilizing activity and decreases automaticity of contractions. Also has class II antiarrhythmic properties.

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