Asian Pacific Society of Cardiology Consensus Recommendations on the Use of MitraClip for Mitral Regurgitation

Transcatheter mitral valve repair with the MitraClip, a catheter-based percutaneous edge-to-edge repair technique to correct mitral regurgitation (MR), has been demonstrated in Western studies to be an effective and safe MR treatment strategy. However, randomised clinical trial data on its use in Asian-Pacific patients is limited. Hence, the Asian Pacific Society of Cardiology convened an expert panel to review the available literature on MitraClip and to develop consensus recommendations to guide clinicians in the region. The panel developed statements on the use of MitraClip for the management of degenerative MR, functional MR, and other less common indications, such as acute MR, dynamic MR, hypertrophic obstructive cardiomyopathy, and MR after failed surgical repair. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted ‘agree’ or ‘neutral’. This consensus-building process resulted in 10 consensus recommendations to guide general cardiologists in the evaluation and management of patients in whom MitraClip treatment is being contemplated.

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Moving beyond the “LDL hypothesis”

VASA ◽

10.1024/0301-1526/a000451 ◽

2015 ◽

Vol 44 (5) ◽

pp. 333-340 ◽

Cited By ~ 7

Author(s):

Christian Werner ◽

Ulrich Laufs

Keyword(s):

Ldl Cholesterol ◽

Causal Relation ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Clinical Trial Data ◽

Randomised Clinical Trial ◽

Trial Data ◽

Low Density Lipoprotein Cholesterol ◽

Genetic Studies ◽

Statin Drug

Abstract. Summary: The term “LDL hypothesis” is frequently used to describe the association of low-density lipoprotein cholesterol (LDL-cholesterol, LDL-C) and cardiovascular (CV) events. Recent data from genetic studies prove a causal relation between serum LDL-C and CV events. These data are in agreement with mechanistic molecular studies and epidemiology. New randomised clinical trial data show that LDL-C lowering with statins and a non-statin drug, ezetimibe, reduces CV events. We therefore believe that the “LDL-hypothesis” has been proven; the term appears to be outdated and should be replaced by “LDL causality”.

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Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

The Heart Surgery Forum ◽

10.1532/hsf98.20111185 ◽

2012 ◽

Vol 15 (5) ◽

pp. 251

Author(s):

Changqing Gao ◽

Chonglei Ren ◽

Cangsong Xiao ◽

Yang Wu ◽

Gang Wang ◽

...

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Surgical Procedures ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Septal Myectomy ◽

The Mean

Background: The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods: Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.Results: All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.Conclusions: Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.

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FINAL STAGES OF CONSENSUS BUILDING PROCESS IN DESIGNATION OF A PRESERVATION DISTRICT FOR GROUPS OF HISTORIC BUILDINGS : A case of Kawagoe(Urban Planning)

AIJ Journal of Technology and Design ◽

10.3130/aijt.9.455_1 ◽

2003 ◽

Vol 9 (17) ◽

pp. 455-458

Author(s):

Taketo OKADA ◽

Atsuyuki OKAZAKI

Keyword(s):

Urban Planning ◽

Consensus Building ◽

Historic Buildings ◽

Building Process

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Hepatology International ◽

10.1007/s12072-014-9580-2 ◽

2014 ◽

Vol 8 (4) ◽

pp. 453-471 ◽

Cited By ~ 308

Author(s):

Shiv Kumar Sarin ◽

◽

Chandan Kumar Kedarisetty ◽

Zaigham Abbas ◽

Deepak Amarapurkar ◽

...

Keyword(s):

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Consensus Recommendations ◽

Asian Pacific

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Consensus Building Process of Goal Image of the City in Historical City Area Noting Transformation of Resident's Opinion and Group

Journal of the City Planning Institute of Japan ◽

10.11361/cpij1.42.0.57.0 ◽

2007 ◽

Vol 42 (0) ◽

pp. 57-57

Author(s):

Michiko Umemiya ◽

Ikumi Sano ◽

Atsuyuki Okazaki

Keyword(s):

Consensus Building ◽

City Area ◽

Building Process ◽

The City

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Re: Liselotte M.S. Boevé, Maarten C.C.M. Hulshof, André N. Vis, et al. Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial. Eur Urol 2019;75:410–8

European Urology ◽

10.1016/j.eururo.2018.11.030 ◽

2019 ◽

Vol 75 (4) ◽

pp. e100 ◽

Cited By ~ 1

Author(s):

Herney Andrés García-Perdomo

Keyword(s):

Prostate Cancer ◽

Clinical Trial ◽

Radiation Therapy ◽

Androgen Deprivation Therapy ◽

Metastatic Prostate Cancer ◽

Clinical Trial Data ◽

Randomised Clinical Trial ◽

Androgen Deprivation ◽

Trial Data ◽

Primary Bone

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In Reply:Office-Based Medication Dispensing

PEDIATRICS ◽

10.1542/peds.84.2.400 ◽

1989 ◽

Vol 84 (2) ◽

pp. 400-400

Author(s):

DANIEL W. SHEA

Keyword(s):

American Academy ◽

Expert Opinion ◽

Consensus Building ◽

Organizational Policy ◽

Executive Board ◽

Hard Data ◽

American Academy Of Pediatrics ◽

Building Process ◽

Ambulatory Medicine ◽

Practice Activity

The statement was developed by the Committee on Practice and Ambulatory Medicine (of which I was then chairman) with the approval and support of the American Academy of Pediatrics' Executive Board. It was designed to respond to the needs of the membership for direction and guidance in this area of practice activity. Establishing organizational policy on an issue such as this for which there are no hard data requires a consensus building process where expert opinion is solicited, competing views are evaluated, and a thoughtful position is fashioned. Our committee, at all times, sought substance, fairness, and balance in formulating the content of this statement.

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Abstract 15934: Refractory Cardiogenic Shock in a Patient With Hypertrophic Obstructive Cardiomyopathy and Mitral Regurgitation Necessitating Intra-Aortic Balloon Pump Use

Circulation ◽

10.1161/circ.130.suppl_2.15934 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Indrajeet Mahata ◽

Michael Faulx ◽

Snigdha kola ◽

Sweta Singh

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Cardiogenic Shock ◽

Pulmonary Edema ◽

Muscle Protein ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Left Ventricular ◽

Afterload Reduction ◽

Intra Aortic Balloon Pump ◽

Refractory Cardiogenic Shock

Introduction: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disease due to a mutation in cardiac muscle protein resulting in left ventricular wall and septal hypertrophy. The presence of systolic anterior motion (SAM) of the mitral valve leads to dynamic left ventricular outflow tract (LVOT) obstruction. With increasing SAM of the anterior mitral leaflet there is resultant loss of coaptation leading to mitral regurgitation (MR). MR has been associated with HOCM but severe MR physiology causing refractory cardiogenic shock and requiring the use of afterload reduction through intra-aortic balloon pump (IABP) is rare and seems paradoxical to the conventional therapy for HOCM. Case summary: This is a case of 71year old female with HOCM, presenting with worsening shortness of breath. She had pulmonary vascular congestion on Chest X-ray and her Transthoracic Echocardiography demonstrated significant LVOT obstruction with moderate MR. She was being evaluated for myomectomy while being treated medically with beta blocker therapy for HOCM. She decompensated with acute respiratory failure from pulmonary edema, her blood pressure and oxygen saturation dropped. She was intubated. Swan- ganz catheter reading suggested wedge pressures of 22 and elevated pulmonary pressures. MvO2 was 32% and this was suggestive of cardiogenic shock. The Trans-esophageal echocardiogram (TEE) showed normal EF with severe concentric LVH and a moderate to severe (3+) MR due to restricted leaflet motion with regurgitant orifice area being 2.5cm2. At that point her MR was the dominant physiology behind her acute decompensation and cardiogenic shock and hence an IABP was placed for reducing afterload that helped in stabilizing her. Subsequently her wedge pressure and MvO2 improved, she was weaned off the IABP and extubated. The patient is being evaluated for myomectomy and mitral valve repair. Conclusion: This case illustrates complex hemodynamics and a challenging management due to competing MR and HOCM physiologies, too much central volume to offset HOCM may worsen MR and pulmonary edema while too much afterload reduction might worsen the HOCM. The use of IABP in a HOCM patient though seems paradoxical but was necessary in this setting to deal with complex physiologies.

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