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Adult Heart Disease – Severe heart Failure-Cardiomyopathy

When the heart muscle does not work well for some reason (such as ischemic cardiomyopathy, dilated cardiomyopathy, myocarditis, etc.), its pumping capability decreases, so sufficient blood cannot be delivered to, or return from, the body. This causes body fluids to accumulate in the lungs or around the body, and is known is heart failure.

Left: Normal / Right: Dilated cardiomyopathy

Symptoms and Diagnosis

Symptoms

When the volume of blood being pumped to the body is insufficient, limbs may become cold, and the face and extremities may be swollen, wit a reduced amount of urine. Also, when blood in the accumulates in the heart, it can burden the lungs, causing shortness of breath or accumulation of fluid in the lungs.

Diagnosis

Cardiac enlargement (cardiomegaly) is identified by chest X-ray, and cardiac hypertrophy and arrhythmia are identifiable by electrocardiogram. In many cases, heart murmurs are also discovered on consultation. Accurate diagnosis of severity is performed by examining the degree of contraction of the heart with echocardiography, or by examining pressure changes in the heart with cardiac catheterization.

Surgical Treatment for Heart Failure

Treatment for heart failure firstly involves pharmaceutical therapy, then some physiological therapy (e.g. pacemaker implantation), but surgical treatment is necessary for severe heart failure that does not improve with these treatments.

Mitral Valve Surgery

When the heart expands due to severe heart failure, the mitral valve, at the entrance of the left ventricle, may be strained, causing mitral regurgitation. Due to this condition, the volume of blood sent to whole body decreases, and blood flowing backwards causes a burden on the lungs, which leads to deterioration of the heart failure condition.
Surgical techniques include use of a prosthetic ring to restrict the enlarged annulus while preserving as much natural tissue as possible, and complete valve replacement with a prosthetic valve. Mitral valve surgery usually makes use of a heart-lung machine, while temporarily stopping the heart, but in our department we wish to put as little a burden on the heart as possible, so we have devised various devices that allow movement of the heart, and surgery without a heart-lung machine.

Coronary Bypass Surgery and Ventriculoplasty Mitral Valve Surgery

Ischemic cardiomyopathy is a condition in which the myocardium does not work well due to a narrowing (stenosis) or obstruction of the coronary arteries that nourish the muscles of the heart. Coronary bypass surgery connects new blood vessels to bypass the blockage and allows sufficient blood to flow other areas. Depending on the condition of the patient, in order to reduce the burden of surgery as much as possible, we may perform off-pump coronary artery bypass graft (OP-CABG) surgery to dispense with the need for stopping the heart and using a heart-lung machine.
In addition, we can also perform left ventricular surgery which removes some tissue to reduce the heart enlarged by ischemic cardiomyopathy. By just improving the shape, this technique reduces the burden on the heart, and improves cardiac function. Although we regularly carry out heart transplants, the shortage of donors in Japan leads us to actively pursue treatments that restore the function of the original organ, when such treatments are appropriate.

Ventricular Assist Devices

We provide the latest treatments

Heart Transplantation

We provide the latest treatments

Heart transplantation is indicated for patients with severe heart failure, whose condition does not improve, even after undergoing the pharmaceutical or surgical treatments above. Since conducting the first brain death heart transplant in February 1999, our hospital has played an important role as a heart transplant facility in Japan. After the Organ Transplant Law was revised in July 2010, the number of transplants has gradually increased, and heart transplantation is becoming established as a standard therapy for severe heart failure in Japan. Regarding pediatric heart transplantation, the number of organs available is still small, and treatment of children with severe heart failure still unfortunately relies on transported organs. This is a problem that must be addressed in the future.

Regenerative Therapy

We provide the latest treatments

Regenerative medicine is a therapy that works using technology such as stem cells, to restore the function of injured cells or tissues. Unlike organ transplantation, it is an innovative treatment that is not limited by any shortage of organ donors, and for this reason research is underway around the world. In our hospital, we have developed a treatment which forms myoblast cells taken from muscles of the patient's own feet into a sheet (Heart Sheet®), which is then transplanted into the heart, and we have obtained assurance that this treatment may be covered by medical insurance. As a result of this treatment, heart function recovers, making surgical treatment for heart failure unnecessary for some patients, while others recovered cardiac function to such an extent that the ventricular assist device could be removed, allowing them once more the lifestyle of a healthy person. We are still at work, researching the clinical application of the pluripotent stem cell technology (iPS) developed in Japan.

Ventricular Assist Devices (VAD)

We provide the latest treatments

The Ventricular Assist Device (VAD) is a mechanical blood pump that sends blood to the body on behalf of the heart, when the heart itself too weak. In Japan, provision of organs for heart transplantation is extremely poor, and it is usually necessary to wait three or four years after the heart transplant has been deemed necessary. While waiting for the transplant, VAD is a proven means to maintain life until the heart transplant can be performed. This is known as a Bridge to Transplantation (BTT). The standard model in the past was an external NIPRO VAD, but since Spring 2011, the use of an implantable VAD has been approved under insurance, and our hospital has equipped over 150 patients with implantable VADs, making us one of the leading facilities in Japan. When using an implantable VAD, there are fewer complications, and it is possible to return home, dramatically improving quality of life while waiting for a heart transplant.
Because of its high success rate and convenience, use as a final treatment instead of heart transplantation has been reported overseas for patients who can not receive a transplant, and clinical trials are currently in progress in Japan. This is known as Destination Therapy (DT). Some patients find their cardiac function restored after using VAD for some time, “resting” their heart. Even removal of the VAD is possible for some such patients. This is known as Bridge to Recovery (BTR).

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