Supravalvular Ring Mitral Stenosis Medication

Updated: Feb 11, 2014
  • Author: Michael D Pettersen, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Medication

Medication Summary

Medical therapy for supravalvar mitral ring consists of drugs to control pulmonary venous congestion and cardiac failure. The 2 main categories of drugs used are diuretics to promote excretion of excess water and positive inotropic drugs to improve myocardial function. Medical therapy helps to relieve symptoms of pulmonary edema and congestive heart failure (CHF) but does not correct the underlying anatomic problem of obstruction.

Antibiotics for endocarditis prophylaxis are no longer recommended for most patients with congenital heart disease. Some significant exceptions are noted, including patients who have previously had endocarditis or patients within 6 months of their surgical repair. Current American Heart Association guidelines also recommend subacute bacterial endocarditis (SBE) prophylaxis for patients who have undergone mitral valve replacement. [12] For more information, see Antibiotic Prophylactic Regimens for Endocarditis.

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Diuretics

Class Summary

These agents are useful to remove excess water that accumulates in heart failure and to relieve symptoms associated with pulmonary edema and peripheral edema.

Furosemide (Lasix)

Drug of choice (DOC) for rapid relief of pulmonary congestion and edema caused by CHF. Useful for maintenance therapy for CHF in patients with supravalvar mitral ring. Promotes renal excretion of water by inhibiting electrolyte-transport system in ascending limb of loop of Henle. Can increase solute and water excretion, even with declining glomerular filtration rate.

Chlorothiazide (Diuril)

Thiazide that increases water excretion by inhibiting reabsorption of sodium chloride in distal renal tubule.

Less potent diuretic than furosemide.

Useful in maintenance therapy of CHF; in severe CHF or refractory edema, thiazides act synergistically with furosemide to promote diuresis.

Hydrochlorothiazide (Esidrix, HydroDIURIL)

Thiazide that increases water excretion by inhibiting reabsorption of sodium chloride in distal renal tubule.

Less potent diuretic than furosemide, useful in maintenance therapy of CHF; in severe CHF or refractory edema, thiazides act synergistically with furosemide to promote diuresis.

Spironolactone (Aldactone)

Counteracts secondary hyperaldosteronism that occurs in cardiac failure; inhibits sodium absorption in collecting duct and has a potassium-sparing diuretic effect. Used alone, produces relatively mild diuresis; however, it may be used with furosemide for synergistic action in severe CHF.

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Inotropic agents

Class Summary

Positive inotropic agents increase the force of myocardial contraction and are used to treat acute and chronic CHF. Some may also provide vasodilatation, improve myocardial relaxation, or increase or decrease the heart rate (positive or negative chronotropic agents, respectively). These additional properties influence the choice of drug for specific circumstances.

Digoxin (Lanoxin)

DOC among inotropic agents. Improves CHF by positive effect on myocardial contraction. Also helps to control fast ventricular rate, especially in atrial arrhythmia. Preparations include elixir 0.05 mg/mL and tabs 0.125 or 0.25 mg.

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