Transposition of the Great Arteries Medication

Updated: Apr 11, 2017
  • Author: John R Charpie, MD, PhD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Medication

Medication Summary

Transposition of the great arteries (TGA) has no specific or recommended drug therapies. Newborn infants with transposition of the great arteries (particularly those with severe left ventricular outflow tract obstruction) may benefit from alprostadil (ie, prostaglandin E1) therapy. Patients with transposition of the great arteries and ventricular septal defect who have not undergone surgical repair, and some patients following complete repair, might potentially benefit from digoxin and diuretic therapy to improve systemic ventricular function and avoid fluid retention.  

For more information, see Antibiotic Prophylactic Regimens for Endocarditis.

All patients require antibiotic prophylaxis prior to dental and indicated surgical procedures in order to reduce the risk of subacute bacterial endocarditis. Thus, all patients require preoperative and postoperative antibiotic prophylaxis for dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. Antibiotic prophylaxis is also recommended for invasive respiratory tract procedures that involve incision or biopsy of the respiratory mucosa (eg, tonsillectomy, adenoidectomy). Antibiotic prophylaxis is not recommended for bronchoscopy unless the procedure involves incision of the respiratory tract mucosa. For invasive respiratory tract procedures to treat an established infection (eg, drainage of abscess, empyema), administer an antibiotic active against Streptococcus viridans.

See the endocarditis prophylaxis guidelines that were revised by the American Heart Association (AHA). [12]

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Inotropic agents

Class Summary

These drugs increase the contractility of cardiac muscle in a dose-dependent manner (ie, positive inotropic effect).

Digoxin (Lanoxin)

Frequently used cardiac glycoside that inhibits the sarcolemmal sodium-potassium adenosine triphosphatase, which leads to an increase in intracellular calcium concentration and increased myocardial contractility.

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Loop diuretics

Class Summary

These drugs inhibit electrolyte reabsorption in the thick ascending limb of the loop of Henle, thus promoting diuresis.

Furosemide (Lasix)

This is a commonly used loop diuretic with moderate diuretic potency. Increases excretion of water by interfering with chloride-binding co-transport system which in turn inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule.

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Prostaglandins

Class Summary

Temporary maintenance of patency of ductus arteriosus in neonates with ductal-dependent congenital heart disease.

Alprostadil IV (Prostin VR)

Identical to the naturally occurring prostaglandin E1 (PGE1) and possesses various pharmacologic effects, including vasodilation and inhibition of platelet aggregation. Temporary maintenance of patency of ductus arteriosus in neonates with ductal-dependent congenital heart disease. Relaxes smooth muscle of the ductus arteriosus. Beneficial in infants with congenital defects that restrict pulmonary or systemic blood flow and who in order to get adequate oxygenation and lower body perfusion, depend on a patent ductus arteriosus.

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