| Project/Area Number |
17K09528
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Research Field |
Cardiovascular medicine
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| Research Institution | Juntendo University |
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Principal Investigator |
Kuwaki Kenji 順天堂大学, 医学(系)研究科(研究院), 准教授 (90398313)
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| Co-Investigator(Kenkyū-buntansha) |
松下 訓 順天堂大学, 医学部, 准教授 (20407315)
山本 平 順天堂大学, 医学部, 先任准教授 (70301504)
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| Project Period (FY) |
2017-04-01 – 2020-03-31
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| Project Status |
Completed (Fiscal Year 2019)
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| Budget Amount *help |
¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000)
Fiscal Year 2019: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
Fiscal Year 2018: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
Fiscal Year 2017: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000)
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| Keywords | 心室中隔肥厚 / 線維化 / 中隔切除 / 大動脈弁狭窄 / 左室流出路狭窄切除 / 心機能 / 線維化組織 / 左室流出路切除 / 心筋収縮力 / 左室肥大 |
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| Outline of Final Research Achievements |
The patients with severe left ventricular outflow tract obstruction, which occurred by hypertrophic cardiomyopathy or aortic valve disease was indication for septal myectomy (SEP). The cardiac function after myectomy showed often more improvement than expected. In or results, the patients who received SEP were significantly higher age and more women population. In addition, more preoperative history of hypertension and higher left ventricular ejection fraction, suggesting that hypertrophy was induced not only by the mechanical stress, but gender difference might also be related. By the histological analysis, the dissected myocardium involved severe fibrotic change on the surface of the endocaridium. Echocardiogram revealed that better contraction recovery at the basal-septal area where myocardium was resected. These results indicated that removal of the fibrotic tissue by the myectomy enhanced the improvement of the cardiac function in the patients with hypertrophic myocardium.
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| Academic Significance and Societal Importance of the Research Achievements |
大動脈弁疾患は高齢化や動脈硬化性疾患の増加に伴い増加の一途である。これまで大動脈弁疾患に合併する左室流出路狭窄は、左室内圧較差が高度な場合にのみ切除の適応とされていた。今回の我々の研究では、肥厚した組織には高度の線維化組織がほぼ全例で認められており、この高架下組織が心機能障害につながっている可能性が示唆された。これを切除することによって組織の収縮性が回復することから、心筋切除の新たな治療適応の一指針となる可能性が示唆されるとともに、心不全への進展予防にもつながることが期待された。
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