Medication Summary
Medical therapy for double orifice mitral valve (DOMV) consists of the use of drugs to control of congestive heart failure (CHF) (eg, digoxin, potassium chloride). [2] The three groups of drugs used are diuretics (to promote excretion of excess water), positive inotropic drugs (to improve myocardial contraction), and vasodilators (to reduce arterial resistance).
Antibiotics for endocarditis prophylaxis are administered to patients before procedures that may cause bacteremia are performed. For more information, see Antibiotic Prophylactic Regimens for Endocarditis.
Diuretics
Class Summary
These drugs promote the excretion of water and electrolytes by the kidneys and are used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention results in edema or ascites. They are useful to remove excess water that accumulates in patients with CHF. They also relieve symptoms associated with pulmonary congestion and reduce peripheral edema.
Furosemide (Lasix)
Drug of choice (DOC) for rapid relief of pulmonary congestion and edema from heart failure. Useful for maintenance therapy of CHF in patients with DOMV. Promotes renal excretion of water by inhibiting electrolyte-transport system in ascending limb of loop of Henle. Increases solute and water excretion, even with declining glomerular filtration rate.
Chlorothiazide (Diuril)
Increases water excretion by inhibiting reabsorption of sodium chloride in distal renal tubule. Less potent than furosemide, thiazide diuretics useful in maintenance therapy of CHF; in severe heart failure or refractory edema, act synergistically with furosemide to promote diuresis.
Hydrochlorothiazide (Esidrix, HydroDIURIL)
Increases water excretion by inhibiting reabsorption of sodium chloride in distal renal tubule. Less potent than furosemide. Useful in maintenance therapy of CHF; in severe heart failure or refractory edema, act synergistically with furosemide to promote diuresis.
Spironolactone (Aldactone)
Counteracts secondary hyperaldosteronism in cardiac failure. Inhibits sodium absorption in collecting duct. Potassium-sparing diuretic effect. Used alone, produces relatively mild diuresis. Can be used with furosemide for synergistic action in severe CHF.
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 to improve cardiac failure because of positive inotropic effect on myocardium. Helps control fast ventricular rate, especially in atrial arrhythmia.
Common preparations in children include tabs 0.125 or 0.25 mg and elixir 0.05 mg/mL. Caps and parenteral injection also available.
Vasodilators
Class Summary
Drugs that produce vasodilation include ACE inhibitors, nitrates, and direct vasodilators (eg, hydralazine). Of these drug classes, ACE inhibitors are frequently used because their adverse effects are the most tolerated. They reduce afterload on the LV by decreasing systemic arterial resistance. ACE inhibitors are particularly helpful in patients with mitral regurgitation, in whom decreased afterload reduces the severity of regurgitation and improves ventricular function. The DOC is captopril. Newer drugs from this category, such as enalapril and lisinopril, are also used for the treatment of CHF, but experience with their use in children is limited.
Captopril (Capoten)
Prevents conversion of angiotensin I to angiotensin II, potent vasoconstrictor. Lowers vascular resistance and aldosterone secretion.
Enalapril (Vasotec)
Competitive ACE inhibitor. Reduces angiotensin II level, potent vasoconstrictor. Lowers vascular resistance and aldosterone secretion.
Lisinopril (Zestril, Prinivil)
Prevents conversion of angiotensin I to angiotensin II, potent vasoconstrictor. Lowers vascular resistance and aldosterone secretion.
-
Double Orifice Mitral Valve. Two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
-
Double Orifice Mitral Valve. Two-dimensional echocardiogram (parasternal short-axis view) shows a double-orifice mitral valve, the orifice divided by a bridge of tissue.
-
Double Orifice Mitral Valve. Two-dimensional echocardiogram of a double-orifice mitral valve (apical view) with color flow mapping, which shows diastolic flow through two separate orifices.
-
Double Orifice Mitral Valve. Two-dimensional echocardiogram (parasternal short-axis view) in a patient with duplicate mitral valve. This diastolic frame shows two typical mitral valve orifices opening into the left ventricle. The two orifices are placed apart, unlike the more common type of double orifice mitral valve (see image above) where the orifice is divided by a bridge of tissue.
-
Double Orifice Mitral Valve. Real-time two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
-
Double Orifice Mitral Valve. Real-time two-dimensional echocardiogram (subcostal short-axis view) in a patient with duplicate mitral valve showing two typical mitral valves opening into the left ventricle. The two orifices are placed apart, unlike the more common type of double orifice mitral valve (see the previous image) where the orifice is divided by a bridge of tissue.
