| Project/Area Number |
19K17605
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| Research Category |
Grant-in-Aid for Early-Career Scientists
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| Allocation Type | Multi-year Fund |
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| Review Section |
Basic Section 53020:Cardiology-related
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| Research Institution | Kyushu University |
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Principal Investigator |
Muraoka Mamoru 九州大学, 医学研究院, 共同研究員 (30747986)
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| Project Period (FY) |
2019-04-01 – 2023-03-31
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| Project Status |
Completed (Fiscal Year 2022)
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| Budget Amount *help |
¥3,900,000 (Direct Cost: ¥3,000,000、Indirect Cost: ¥900,000)
Fiscal Year 2021: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000)
Fiscal Year 2020: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000)
Fiscal Year 2019: ¥2,730,000 (Direct Cost: ¥2,100,000、Indirect Cost: ¥630,000)
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| Keywords | フォンタン / 血行動態 / 心房中隔欠損症 / 心房中隔欠損 / Fontan手術 / 血行動態予測 / Fontan / fenestration |
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| Outline of Research at the Start |
Fontan手術時に作成されたfenestrationは術後遠隔期にチアノーゼが問題となるため閉鎖を試みる。しかし試験閉鎖で静脈圧上昇や心拍出量低下がみられる場合は閉鎖できない。一方でfenestrationが低心拍出量や静脈圧高値を防ぐこともある。fenestrationが血行動態に与える影響は患者ごとの心機能、血管抵抗などに依存し、その治療適応を一律に定めることは難しい。シミュレータの有用性をイヌ心房中隔欠損（ASD）モデルとヒトASD患者で立証する。その心房間の機能的抵抗を取り入れたシミュレータでヒトFontan術後患者の孔閉鎖が血行動態循環に及ぼす影響を予測できるかを明らかにする。
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| Outline of Final Research Achievements |
The fenestration to reduce central venous pressure in the Fontan circulation is generally attempted to be closed to prevent long-term cyanosis in the remote phase. However, some patients are found to have hemodynamics unsuitable for fenestration closure due to high central venous pressure after trial closure. The purpose of this study is to quantitatively predict hemodynamics after fenestration closure.
Prior to the prediction for fenestration closure, we have demonstrated that the predicted hemodynamics after closing an ASD, which is a defect between chambers of low pressure analogous to the Fontan fenestration, matched well with those experimentally measured. The model also showed that the risk of pulmonary edema after ASD closure depends on the balance of right and left cardiac functions. The model predictions in Fontan patients were not validated within the study period.
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| Academic Significance and Societal Importance of the Research Achievements |
Fontan循環におけるfenestrationに先立ち、世界で初めてASDが与える血行動態変化を予測できることを立証した。高齢者では左心機能低下に起因するASD閉鎖後の肺水腫増悪のリスクを考慮する必要があり、本研究は事前の治療適応の判断、治療後の安全な管理に貢献できる。また本研究の予測モデルは、同じ低圧系の孔であるfenestrationの治療適応を選定するFontan患者個別医療の基盤となることが期待される。
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