Target disease,treatment

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Conditions treated

• Dilated cardiomyopathy
  Dilated cardiomyopathy is characterized by diffuse left ventricular systolic dysfunction and left ventricular dilation. It may be ameliorated by appropriate oral medication, but once myocardial strength is irreversibly reduced, advanced treatments such as mechanical circulatory support and heart transplantation are required. It is designated as an intractable disease.
• Hypertrophic cardiomyopathy/strong>
  Hypertrophic cardiomyopathy is a condition in which the myocardium becomes abnormally thick even though there are no underlying conditions such as hypertension. Hypertrophic obstructive cardiomyopathy in particular requires advanced treatment because it is associated with a high risk of sudden death. It is designated as an intractable disease.
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• Aortic stenosis (the door of the heart, i.e., the aortic valve, does not open sufficiently)/strong>
  Aortic stenosis is a condition in which the aortic valve, the exit of the heart, does not open sufficiently due to sclerosis. Once symptoms develop, heart failure progresses rapidly. Even without symptoms, some cases of severe stenosis may take a sudden turn for the worse. Invasive surgery was previously the only option for radical cure, but less invasive catheter-based treatment has become a treatment option for patients who are high-risk surgical candidates.
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• Aortic regurgitation (the door of the heart, i.e., the aortic valve, does not close completely)/strong>
  Aortic regurgitation is a condition in which blood flows back into the heart due to incomplete closure of the aortic valve. Severe regurgitation imposes a continuous burden on the heart. The timing of surgery is determined based on the degree of heart enlargement.
• Mitral stenosis/strong>
  Mitral stenosis is a condition in which the mitral valve, which is located between the left ventricle and the left atrium, becomes stenotic. Severe mitral stenosis causes shortness of breath and palpitations. This condition requires surgery, but some cases may be treated with catheter-based treatment (e.g., percutaneous transvenous mitral commissurotomy).
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• Mitral regurgitation/strong>
  Severe regurgitation of the mitral valve leads to enlargement of the heart and results in symptomatic heart failure. The treatment approach is determined based on accurate evaluation of regurgitation volume and cardiac function. Currently, various treatment options, including minimally invasive surgery and catheter-based treatment, are available. The optimal approach is selected based on the disease state.
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• Infective endocarditis/strong>
  Infective endocarditis is a sepsis caused by a bacterial mass attached to the valves and endocardium, which causes conditions such as vascular embolization and heart damage. It requires accurate diagnosis and effective antimicrobial agents as well as early detection and treatment of complications.
• Cardiac sarcoidosis/strong>
  Cardiac sarcoidosis is a condition in which nodes called granulomas that contain epithelioid cells and lymphocytes form on various organs, including the heart. It is considered a hypersensitivity immune reaction. Treatments such as steroids and immunosuppressive drugs as well as specialized knowledge and diagnosis are required for this disease. It is designated as an intractable disease.
• Constrictive pericarditis

Diagnostic approaches

• Echocardiography
  Echocardiography allows for observation of the motions of the heart and valves, measurement of intracardiac pressure, and detection of abnormal structures via the use of ultrasound from the surface of the body. This examination requires skill and experience. In the Division of Heart Failure, skilled technicians and doctors perform echocardiography in collaboration. Treatment approaches are determined based on accurate quantitative echocardiography.
• Transesophageal echocardiography
  As with gastroendoscopy, a probe for echocardiography is inserted into the esophagus, which is located behind the heart. It allows for detection of thrombosis and close observation of valves that are difficult to visualize with echocardiography from the body surface. It has become an essential examination for safe catheterization or surgery.
• Exercise echocardiography
  Some types of heart disease are induced by exercise even though no abnormalities are observed at rest. Such diseases can be detected by this examination. During echocardiography, patients pedal a bicycle in the supine position.
• Dobutamine stress echocardiography
  Dobutamine stress echocardiography uses a drug to increase the heart rate to simulate exercise. Although it requires a drip infusion, it has less influence of respiration compared with exercise. Therefore, it is performed when precise measurement is required.
• Coronary echocardiography
  Echocardiography is performed instead of a catheterization study when a drug is used to stress the heart. A wire is inserted into the coronary arteries and the degree of stenosis is functionally evaluated. It does not require hospitalization and can be performed repeatedly. It is required to produce images of coronary flow of several millimeters with the use of ultrasound from the surface of the body.
• Cardiac magnetic resonance imaging （MRI）
  Cardiac MRI can visualize the morphology and motion of the heart as well as tissue changes using contrast media that do not damage the heart.
• Positron-emission tomography （PET） and other types of myocardial scintigraphy
• Catheterization study (including myocardial biopsy)
  A catheterization study measures the pressure in the heart and the volume of blood ejected by the heart to accurately understand the functioning of the heart as a pump. In myocardial biopsy, a small amount of the myocardium collected from a patient is processed and observed under a microscope to evaluate the degree of abnormality or damage. Biopsy is performed by a skilled doctor. It is completed in a short time without pain.
• Genetic testing
  Since some heart diseases are heritable, genetic testing is performed at patient's request.

Treatment approaches

• Heart failure education program (Patients are admitted for a short period to learn about self-care for heart failure.)
• Treatment for acute decompensation of heart failure
• Medications (β-blockers, RAS inhibitors, anti-arrhythmic drugs, anti-aldosterone drugs, etc.)
• Treatment for sleep apnea
• Cardiac resynchronization therapy (CRT, CRT-D)
• Percutaneous transvenous mitral commissurotomy (PTMC)
• Percutaneous transluminal septal myocardial ablation (PTSMA)
• Enzyme replacement therapy (for Fabry disease)
• Transcatheter aortic valve implantation (TAVI)
• Transcatheter mitral valve repair using the MitraClipR
• Mechanical circulatory support for severe heart failure
• Consideration of heart transplantation
• Clinical studies and advanced medical care

last updated : 2023/04/05