Cardiovascular Medicine

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Patient Care

Internal Medicine Department in the Cardiovascular Center covers all diseases related to the heart and vessels. Our major target diseases are 1. ischemic heart disease (angina pectoris, myocardial infarction), 2. arrhythmia, 3. heart failure, 4. hypertension, 5. cardiomyopathy, 6. valvular heart disease, 7. pericardial / endocardial disease, 8. arterial disease, 9. venous thrombosis (including pulmonary embolism), 10. pulmonary hypertension, 11. congenital heart disease. We provide rapid and proper medical management in close cooperation with Cardiovascular Intervention Department and Arrhythmia Center as well as the Cardiovascular Surgery Department. We also provide a lot of advanced medical care and we are able to perform almost all examinations and treatments associated with circulatory diseases.
Specific overview on cardiac CT scan, transcatheter aortic valve Implantation, catheter ablation is shown below.

1. Cardiac CT Scan (Fig.1)

Cardiac CT scan is a noninvasive examination which enables us to assess the coronary artery nourishing the heart. Scoring the level of coronary arteriosclerosis helps us assess a coronary lesion more precisely. Calcium scoring is useful for the assessment of asymptomatic patients and can be used as a clinical intervention for the purpose of a primary prevention measure against ischemic heart disease. Cardiac CT allows us to assess severity of coronary stenosis with high diagnostic yield, so that we can find more precisely the patients in need of coronary catheterization. We have the latest CT scanner (Flash) specialized in cardiac CT scan and try to decrease in radiation dose. Recently, cardiac CT image became able to derive fractional flow reserve (FFR), which can be measured only by the coronary artery catheterization. It is called FFRCT. We have introduced it earlier than any other hospitals in Japan. It allows us to assess noninvasively whether the patients are eligible for catheter intervention or not. We combine other modalities to assess ineligible patients for cardiac CT scan (with high calcification, small stent, arrhythmia, tachycardia, etc.).
Fig.1
Fig.1

2. Transcatheter Aortic Valve Implantation (Fig.2)

Radical treatment for aortic stenosis is surgery. It is a procedure of opening the chest, extirpating the calcified / degenerated aortic valve under cardiac arrest, and transplanting a new prosthetic valve (mechanical valve, tissue valve). It puts a great strain on the patients. It takes about 4 hours to complete the procedure and about 3 weeks of average period of hospitalization. Transcatheter Aortic Valve Implantation (TAVI), which is a new procedure established recently, enables us to place a prosthetic valve in the patients’ heart by catheterization without thoracotomy and cardiac arrest. This treatment is eligible for frail aged patients and patients at high risk of any other diseases. It puts lesser strain on the patients and takes shorter period of hospitalization. It takes about 2 hours to complete this treatment and about 1 week of average period of hospitalization. Both of surgical aortic valve implantation and TAVI are useful treatments, and we try to choose better treatment for each patient after carefully reviewing in the Heart Team.
Fig.2
Fig.2

3. Catheter Ablation (Fig.3)

Catheter ablation is a radical treatment for arrhythmia. It is often applied to atrial fibrillation recently. We try to proactively perform catheter ablation to the symptomatic patients with paroxysmal atrial fibrillation. We also perform it to the patients with atrial fibrillation poorly controlled by anti-arrhythmic medication. We basically choose pulmonary vein isolation (PVI) method. For intractable atrial fibrillation, we use mapping equipment and aim to cure it radically. We choose the best ablation catheter for each case among various kinds of them. We usually administer anticoagulant to our patients during perioperative period, but we try to discontinue administering anticoagulant to the patients at lower risk for cerebral embolism after finishing catheter ablation. We use a transcatheter left atrial appendage closure device (WATCHMAN) for the patients who need to take anticoagulant but cannot take it over long periods.
Fig.3
Fig.3