MEDICAL THERAPIES

The true resolutive therapy of congenital heart diseases is the surgical intervention of correction of the heart disease. However, the majority of children with congenital heart disease requires medical therapies prior to the surgical correction.

Medical treatment is necessary when the heart diseases are complicated by heart failure (the heart is unable to assure a sufficient supply of blood and thus of oxygen to the body tissues). Digitalis is the drug most widely employed to treat the heart failure. This drug increases the strength of the heartıs contraction and enables the heart to cope with the over-exertion related to the presence of the heart disease. Moreover, digitalis also has a regulatory effect on some types of rhythm disorders.

Digitalis may be administered by oral or intravenous route and the initial step of therapy requires a careful monitoring to identify the onset of side-effects or of signs of toxicity which consist in nausea, vomiting and, especially, in cardiac rhythm disorders. The onset of these signs or effects require a dose reduction.

The package with the digitalis preparation should always be stored in a place out of the reach of children, in order to prevent accidental ingestion which could be very dangerous.

One of the consequences of heart failure is the reduced production of urine and, accordingly, the retention of fluids and salts. This problem is treated with the administration of diuretic agents which counter-balance the tendency to retain fluids and could be administered by oral and intramuscular or intravenous route. Other drugs which are useful in therapy of heart failure are vasodilators. Their effect is to reduce the resistance which has to be overcome by the heart to make blood to circulate and in practice reduce the heartıs overworking. Vasodilators are administered by oral route.

Finally, when a heart disease reaches the heart failure or when it causes a remarkable cyanosis, the child has a reduced oxygen availability. In these cases, the respiration of air enriched with oxygen partly replaces the resulting deficiency and is useful for the patient. Generally, oxygen is administered in hospital settings, but, in special cases, oxygen therapy may also be performed at home.

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