先端医療シリーズ12 心臓病 心臓病の最新医療

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近年医学、医療の進歩は著しいが、最も急速な深奥を遂げている領域の一つが循環器疾患、殊に心臓病に対する医療ではないだろうか。（序文より）

目次

  • 表紙
  • カラーグラビア
  • 著者一覧
  • 本書を推薦する
  • 本書を推薦する
  • 序文
  • 目次
  • 序章
  • 心臓病診療の課題と展望
  • 第1章 心臓病診断の21世紀への展望
  • 1. ゲノム時代の遺伝子診断・遺伝子治療
  • 1.1 はじめに
  • 1.2 ポストゲノム計画時代の遺伝子診断
  • 1.2.1 遺伝子診断の基礎
  • 1.2.1.1 単一遺伝子病と多因子疾患
  • 1.2.1.2 遺伝子診断の概念
  • 1.2.1.3 遺伝子診断の意義と限界
  • 1.2.2 遺伝的多型性とその検出
  • 1.2.2.1 遺伝的多型性
  • 1.2.2.2 SNPs
  • 1.2.2.3 DNA多型の検出法
  • 1.2.2.4 DNAアレイテクノロジー
  • 1.2.3 循環器疾患の遺伝子診断の現状
  • 1.2.3.1 単一遺伝子病
  • 1.2.3.2 多因子疾患とDNA多型
  • 1.2.4 循環器疾患の遺伝子診断の将来
  • 1.2.4.1 新規疾患関連遺伝子の同定と遺伝子診断
  • 1.2.4.2 DNA多型とゲノムビジネス
  • 1.2.4.3 疾患の再分類
  • 1.2.4.4 DNA多型とテーラーメイド医療
  • 1.2.4.5 DNA多型の人種差と我が国の取り組み
  • 1.2.4.6 テーラーメイド健康管理
  • 1.2.4.7 遺伝子発現プロファイルの診断
  • 1.2.5 遺伝子診断の倫理的問題
  • 1.3 ゲノム時代の遺伝子治療
  • 1.3.1 遺伝子治療の展開
  • 1.3.2 遺伝子治療の基本戦略
  • 1.3.2.1 遺伝子治療の概念
  • 1.3.2.2 遺伝子を変えない遺伝子治療
  • 1.3.2.3 遺伝子を変える遺伝子治療
  • 1.3.3 遺伝子導入の方法
  • 1.3.4 遺伝子治療の標的
  • 1.3.4.1 標的遺伝子
  • 1.3.4.2 標的細胞
  • 1.3.5 循環器疾患の遺伝子治療の現状
  • 1.3.5.1 閉塞性動脈硬化症
  • 1.3.5.2 虚血性心疾患
  • 1.3.6 循環器疾患の遺伝子治療の将来
  • 1.3.6.1 血管開存療法
  • 1.3.6.2 心筋再生(新生)療法
  • 1.3.6.3 先天性心疾患の根治療法
  • 1.3.6.4 血圧降下療法
  • 1.3.6.5 その他
  • 1.4 おわりに
  • 2. 大規模臨床試験
  • 2.1 はじめに
  • 2.2 大規模臨床試験の必要性
  • 2.3 臨床疫学の歴史
  • 2.4 大規模臨床試験の位置付け
  • 2.4.1 臨床研究デザイン
  • 2.4.2 無作為化はなぜ必要か
  • 2.5 大規模臨床試験の読み方
  • 2.5.1 方法の妥当性について
  • 2.5.2 結果について
  • 2.6 大規模臨床試験と循環器疾患
  • 2.6.1 慢性心不全の大規模臨床試験
  • 2.6.2 急性冠症候群の大規模臨床試験
  • 2.6.3 不整脈の大規模臨床試験
  • 2.7 欧米の大規模臨床試験の結果はどこまで日本に適応できるか
  • 2.8 海外における臨床試験の現状と日本との比較
  • 2.8.1 海外における臨床試験の動向
  • 2.8.2 わが国における大規模臨床試験の問題点とその対策
  • 2.8.3 海外におけるクリニカル・コーディネータの役割
  • 2.9 おわりに
  • 3. 心臓病のEBM
  • 3.1 はじめに
  • 3.2 心不全のEBM
  • 3.2.1 強心薬
  • 3.2.2 ACE阻害薬
  • 3.2.3 アンジオテンシンII受容体拮抗薬
  • 3.2.4 β遮断薬
  • 3.2,5 Ca拮抗薬
  • 3.2.6 「心不全のEBM」まとめ
  • 3.3 虚血性心疾患のEBM
  • 3.3.1 再灌流療法
  • 3.3.2 薬物治療
  • 3.4 おわりに
  • 4. ES細胞と臓器移植
  • 4.1 はじめに
  • 4.2 ES細胞とin vitro分化
  • 4.3 ES細胞から特定の分化細胞の誘導
  • 4.4 心血管系の細胞への分化誘導
  • 4.4.1 心筋細胞
  • 4.4.2 血管構成細胞
  • 4.5 移植への応用
  • 4.6 今後の展望
  • 4.6.1 現在樹立されたヒトES細胞は、これまで解析に用いられてきたマウスES細胞と相同なものと見なしうるか?
  • 4.6.2 ES細胞以外に移植可能な細胞は存在しないのか?
  • 4.7 おわりに
  • 5. 再生医療
  • 5.1 はじめに
  • 5.2 心筋細胞再生に至るまでの研究の流れ
  • 5.3 成人における未分化幹細胞
  • 5.4 骨髄間葉系幹細胞の特徴
  • 5.5 間葉系幹細胞から心筋細胞への分化誘導
  • 5.6 遺伝子発現から見たCMG細胞の表現型
  • 5.7 CMG細胞の活動電位と受容体発現
  • 5.8 心筋細胞移植と心不全治療
  • 5.9 おわりに
  • 6. MICS(Minimally Invasive Cardiac Surgery)とロボット心臓手術
  • 6.1 はじめに
  • 6.2 MICSの歴史
  • 6.3 低侵襲心臓手術(MICS)の定義
  • 6.4 開心術におけるMICSの利点
  • 6.5 低侵襲心臓手術(MICS)の分類
  • 6.5.1 Standard MICS
  • 6.5.2 Port-Access MICS
  • 6.5.2.1 EAC(End Aortic Clamp)Balloon法
  • 6.5.2.2 AXC(Aortic Cross Clamp)法
  • 6.6 慶應義塾大学病院におけるPort-Access心臓手術の経験
  • 6.7 わが国におけるPort-Access MICSの今後
  • 6.8 ロボット心臓手術
  • 6.8.1 コンピュータ制御手術装置
  • 6.8.2 da VinciTM装置
  • 6.8.3 臨床応用経緯
  • 6.8.4 MICSにおけるロボットの導入
  • 6.8.5 da VinciTM装置とZEUS装置
  • 6.8.6 ロボットによるOff-pump Totally Endoscopic CABG
  • 6.8.7 ロボット手術の今後の課題
  • 6.9 おわりに
  • 第2章 心臓病の分子生物学
  • 1. 遺伝子疾患と遺伝子解析
  • 1.1 はじめに
  • 1.2 病因変異と疾患関連多型
  • 1.3 先天性心疾患における遺伝子異常
  • 1.4 心筋症における遺伝子異常
  • 1.4.1 HCMにおける遺伝子異常
  • 1.4.2 DCMにおける遺伝子異常
  • 1.4.3 その他の心筋症における遺伝子異常
  • 1.5 不整脈における遺伝子異常
  • 1.5.1 QT延長症候群(LQTS)における遺伝子異常
  • 1.5.2 その他の不整脈における遺伝子異常
  • 1.6 おわりに
  • 2. 循環調節ペプチド、サイトカイン、NO
  • 2.1 はじめに
  • 2.2 培養細胞系での知見からみた循環調節ペプチド、NO、サイトカインの作用
  • 2.3 心筋炎・心筋症と心不全
  • 2.3.1 心筋炎・心筋症、心不全と循環調節ペプチド
  • 2.3.2 心筋炎・心筋症、心不全とNO、サイトカイン
  • 2.4 虚血性心疾患
  • 2.4.1 虚血性心疾患と循環調節ペプチド
  • 2.4.2 虚血性心疾患とNO、サイトカイン
  • 2.5 おわりに
  • 3. 心臓血管内分泌
  • 3.1 はじめに
  • 3.2 ナトリウム利尿ペプチド系の基礎
  • 3.2.1 ANP、BNPの生合成・分泌
  • 3.2.2 ANP・BNPの作用
  • 3.2.3 遺伝子変異動物の結果
  • 3.3 ANP・BNPの臨床応用
  • 3.3.1 診断薬としての有用性
  • 3.3.2 治療薬としての臨床応用
  • 4. 冠動脈の病理
  • 4.1 はじめに
  • 4.2 ヒトにおける心移植後冠動脈病変の病理
  • 4.3 危険因子
  • 4.4 GCA成立の機序
  • 4.5 免疫抑制剤とGCA
  • 4.5.1 シクロスポリンA(cyclosporin A)
  • 4.5.2 FK506
  • 4.5.3 ラパマイシン(rapamycin)
  • 4.5.4 デオキシスパガリン(15-deoxyspergualin)
  • 4.5.5 RS-61443(mycophenolate mofetil)
  • 4.5.6 遺伝子治療とGCA
  • 4.6 おわりに
  • 第3章 臓器移植と再生
  • 1. 心臓移植
  • 1.1 はじめに
  • 1.2 本邦における心臓移植の現況
  • 1.2.1 心移植の適応基準
  • 1.2.2 日本臓器移植ネットワークへの適応患者の登録
  • 1.2.3 心ドナーの適応基準
  • 1.2.4 ドナー・レシピエントの適合
  • 1.2.5 心臓移植手術
  • 1.2.6 心臓移植後の管理(follow-up)
  • 1.3 世界における心臓移植の現状
  • 1.4 機械的循環補助
  • 1.5 我が国における心臓移植症例
  • 1.6 社会的環境と今後の展望
  • 2. 心筋細胞移植(Cardiac cell transplantation)
  • 2.1 はじめに
  • 2.2 細胞移植の種類(Cell transplantation)
  • 2.2.1 他家細胞(Allograft)
  • 2.2.2 異種細胞(xenograft)
  • 2.2.3 自家細胞(Autograft)
  • 2.2.4 骨格筋芽細胞(Skeletal myoblast, Satellite cell)
  • 2.2.5 骨髄細胞(Bone marrow cell)
  • 2.2.6 成熟心筋細胞(Adult cardiomyocyte)
  • 2.2.7 平滑筋細胞(smooth muscle cell)
  • 2.3 拡張型心筋症(DCM)
  • 2.4 心機能改善寄与因子
  • 2.4.1 物理的な伸展抑制
  • 2.4.2 移植部の局所心機能
  • 2.4.3 ホストとドナー間の電気生理学的な同期収縮
  • 2.4.4 血管新生(Angiogenesis)
  • 2.4.5 その他
  • 2.5 細胞移植全般における諸問題
  • 2.5.1 移植方法
  • 2.5.2 必要な細胞量
  • 2.6 心筋組織の開発(Bioengineered cardiac graft)
  • 2.7 凍結保存(Cryopreservation)
  • 2.8 細胞追跡(Cell tracking)
  • 2.9 大型動物モデル
  • 2.10 ヒト細胞の利用
  • 2.11 臨床応用化
  • 2.12 おわりに
  • 3. 血管新生と再生
  • 3.1 はじめに
  • 3.2 胎生期における血管形成
  • 3.3 血管新生療法の基礎研究
  • 3.3.1 血管増殖因子
  • 3.3.2 骨髄由来血管内皮前駆細胞
  • 3.3.3 ハイポキシアと血管新生
  • 3.4 血管新生療法の臨床試験
  • 3.4.1 慢性閉塞性動脈硬化症に対する臨床試験
  • 3.4.2 虚血性心疾患に対する臨床試験
  • 3.4.3 血管新生療法の問題点
  • 3.4.4 今後の展望
  • 3.5 培養血管の開発
  • 3.6 老化血管の再生
  • 4. 遺伝子改変ブタを用いた異種移植の可能性
  • 4.1 はじめに
  • 4.2 異種移植の現況と課題
  • 4.2.1 歴史的背景
  • 4.2.2 異種移植を実用化するための戦略
  • 4.3 社会的効果
  • 4.4 将来の展望
  • 第4章 冠動脈疾患の最新治療
  • 1. 川崎病
  • 1.1 はじめに
  • 1.2 診断
  • 1.3 非定型例の診断
  • 1.4 川崎病冠状動脈病変の自然歴
  • 1.5 冠状動脈以外の血管病変
  • 1.6 川崎病血管炎と動脈硬化
  • 1.7 川崎病後遺症としての成人虚血性心疾患
  • 1.8 川崎病血管炎の病理
  • 1.9 川崎病病因の検索
  • 1.10 おわりに
  • 2. 急性冠症候群
  • 2.1 はじめに
  • 2.2 ACSの発症機序
  • 2.3 不安定プラーク(vulnerable plaque)
  • 2.4 ACSの診断
  • 2.4.1 トロポニンT
  • 2.4.2 血管内視鏡
  • 2.5 ACSの治療
  • 2.5.1 HMG-CoA還元酵素阻害薬
  • 2.5.2 Gp IIb/IIIa
  • 2.5.3 低分子量ヘパリン(low molecular weight heparin)
  • 2.6 おわりに
  • 3. TMLR (レーザー心筋内血行再建術)
  • 3.1 イントロダクション
  • 3.2 歴史的背景
  • 3.3 効果の理論的考察および実験結果
  • 3.3.1 左室内腔からの血流灌流
  • 3.3.2 血管新生
  • 3.3.3 除神経効果
  • 3.3.4 手術の創痛による狭心痛自覚闘値の上昇
  • 3.3.5 placebo効果
  • 3.4 各種レーザー装置の特徴
  • 3.4.1 チャネル作成の仕方
  • 3.4.2 心電図同期
  • 3.4.3 熱損傷の強さ
  • 3.4.4 フレキシブルファイバーに搭載可能か
  • 3.5 Prospective Randomized Study(無作為割付試験)
  • 3.5.1 TMLRと内科治療の比較
  • 3.5.2 CABG+TMLR(Adjunctive TMLR)とCABG単独症例の比較
  • 3.5.3 我が国における炭酸ガスレーザによるTMLRの臨床治験結果
  • 3.6 PMLRの現況とTMLRとの比較
  • 3.6.1 血管新生PMLRの現況
  • 3.6.2 TMLRとの比較
  • 3.7 今後の展望
  • 4. 低侵襲冠動脈バイパス術
  • 4.1 はじめに
  • 4.2 心拍動下手術の功罪
  • 4.2.1 Coronary motion
  • 4.2.2 Coronary flowの遮断と無血野
  • 4.2.3 血行動態の不安定化
  • 4.3 適応
  • 4.3.1 MIDCAB
  • 4.3.2 OPCAB
  • 4.4 周術期管理
  • 4.4.1 麻酔管理
  • 4.4.2 術後管理
  • 4.5 MIDCAB(access reduction)
  • 4.5.1 LAST手術方法
  • 4.5.2 Lower ministernotomy approach
  • 4.5.3 LCXへのMIDCAB
  • 4.5.4 RCAへのMIDCAB
  • 4.5.5 再手術症例に対するMIDCAB
  • 4.6 OPCAB
  • 4.7 手術成績
  • 4.8 Is this "really" or "fantasy" ?
  • 4.9 おわりに
  • 5. PTCA (ロータブレーター、ステントを含む)
  • 5.1 はじめに
  • 5.2 ロータブレーター
  • 5.3 ステント
  • 6. 冠インターベンション後再狭窄
  • 6.1 はじめに
  • 6.2 各種冠インターベンションによる再狭窄
  • 6.2.1 経皮的血管形成術(PTCA)
  • 6.2.2 冠動脈ステント
  • 6.2.3 Directional Coronary Atherectomy(DCA)
  • 6.2.4 Cutting balloon
  • 6.2.5 ロータブレーター
  • 6.2.6 レーザー冠動脈形成術
  • 6.3 冠インターベンション後再狭窄に対する治療法
  • 6.3.1 薬物療法
  • 6.3.1.1 抗血栓療法
  • 6.3.1.2 抗アレルギー剤
  • 6.3.1.3 プロブコール
  • 6.3.1.4 その他
  • 6.3.2 遺伝子治療
  • 6.3.3 放射線療法
  • 6.4 おわりに
  • 第5章 弁膜疾患の最新治療
  • 1. 急性リュウマチ熱
  • 1.1 はじめに
  • 1.2 疫学
  • 1.3 症状
  • 1.3.1 心臓
  • 1.3.2 関節
  • 1.3.3 脳
  • 1.3.4 皮膚
  • 1.4 診断
  • 1.5 治療
  • 1.5.1 心炎
  • 1.5.2 溶連菌駆除、再発予防
  • 1.5.3 咽頭炎の治療
  • 2. Ross手術
  • 2.1 緒言・Ross手術の利点
  • 2.2 Ross手術の手術適応
  • 2.2.1 小児における適応と禁忌
  • 2.2.2 成人における適応と禁忌
  • 2.3 術式の変遷と現況
  • 2.3.1 subcoronary implantation法
  • 2.3.2 intra-aortic cylinder法
  • 2.3.3 total aortic replacement
  • 2.3.4 graft-host size mismatchを呈する症例
  • 2.4 Total aortic root replacementの手術手技
  • 2.4.1 Pulmonary Autograft採取
  • 2.4.2 Total aortic root replacement法によるAutograft縫着
  • 2.4.3 Dilated Aortic Annulusに対する弁輪縫縮
  • 2.4.4 Ross-Konno法
  • 2.5 手術・遠隔成績
  • 2.6 小児におけるAutograftの成長
  • 2.7 Ross手術今後の展望
  • 3. 高齢者の弁置換手術
  • 3.1 はじめに
  • 3.2 高齢化社会の現状
  • 3.2.1 日本の平均寿命・平均余命
  • 3.2.2 平均寿命の国際比較
  • 3.2.3 平均健康寿命
  • 3.3 高齢者の弁置換術
  • 3.3.1 高齢者心臓手術の特徴
  • 3.3.2 高齢者弁置換術の問題点
  • 第6章 先天性心疾患の最新治療
  • 1. 小児の心臓移植
  • 1.1 はじめに
  • 1.2 心臓移植適応と心臓移植適応疾患
  • 1.2.1 小児と成人の異なる点
  • 1.2.2 移植適応症例の提示
  • 1.3 心臓移植適応の観点から見た拡張型心筋症の鑑別診断
  • 1.4 拡張型心筋症における外科的手術
  • 1.5 補助循環
  • 1.6 小児心臓移植の現況
  • 1.6.1 海外の小児心臓移植の現況(国際心肺移植学会の統計)
  • 1.6.2 本邦小児渡航心臓移植の現状
  • 2. カテーテルによる心奇形の治療
  • 2.1 はじめに
  • 2.2 心房中隔欠損: 拡大術
  • 2.2.1 適応
  • 2.2.2 方法
  • 2.2.3 成績
  • 2.3 心房中隔欠損、心室中隔欠損: 閉鎖術
  • 2.3.1 適応
  • 2.3.2 方法
  • 2.3.3 成績
  • 2.4 動脈管開存症: 閉鎖術
  • 2.4.1 適応
  • 2.4.2 方法
  • 2.4.3 成績
  • 2.5 側副動脈、動静脈瘻、血管腫: 閉鎖術
  • 2.5.1 適応
  • 2.5.2 方法
  • 2.5.3 成績
  • 2.6 肺動脈弁狭窄、肺動脈弁閉鎖: 拡大術
  • 2.6.1 適応
  • 2.6.2 方法
  • 2.6.3 成績
  • 2.7 大動脈弁狭窄
  • 2.7.1 適応
  • 2.7.2 方法
  • 2.7.3 成績
  • 2.8 僧帽弁狭窄: 拡大術
  • 2.8.1 適応
  • 2.8.2 方法
  • 2.8.3 成績
  • 2.9 大動脈縮索: 拡大術
  • 2.9.1 適応
  • 2.9.2 方法
  • 2.9.3 成績
  • 2.10 肺動脈末梢狭窄、右室肺動脈導管狭窄: 拡大術
  • 2.10.1 適応
  • 2.10.2 方法
  • 2.10.3 成績
  • 3. Fontan型手術: 術式に関する最近の動向
  • 3.1 はじめに
  • 3.2 Fontan型手術の成績
  • 3.2.1 対象と方法
  • 3.2.2 手術適応条件
  • 3.2.3 結果
  • 3.3 術式に関する最近の動向
  • 3.3.1 手術戦略
  • 3.3.2 術式
  • 3.3.3 fenestrated Fontan法
  • 3.3.4 周術期管理
  • 3.4 術後遠隔期の諸問題
  • 4. 成人になった心奇形術後患者の管理
  • 4.1 成人になった心奇形術後患者の実態
  • 4.2 疾患特有の術後に問題となる病態と管理
  • 4.2.1 心房中隔欠損症
  • 4.2.1.1 病態
  • 4.2.1.2 管理
  • 4.2.2 心室中隔欠損症
  • 4.2.2.1 病態
  • 4.2.2.2 管理
  • 4.2.3 心内膜床欠損症
  • 4.2.3.1 病態
  • 4.2.3.2 管理
  • 4.2.4 大動脈弁狭窄症
  • 4.2.4.1 病態
  • 4.2.4.2 管理
  • 4.2.5 大動脈縮窄症
  • 4.2.5.1 病態
  • 4.2.5.2 管理
  • 4.2.6 ファロー四徴症
  • 4.2.6.1 病態
  • 4.2.6.2 管理
  • 4.2.7 大血管転換症
  • 4.2.7.1 完全大血管転換症での心房内血流転換術後
  • 4.2.7.2 修正大血管転換症術後
  • 4.2.7.3 管理
  • 4.2.8 総肺静脈還流異常症
  • 4.2.9 チアノーゼ性心疾患姑息術後
  • 4.3 術式に特有の術後に問題となる病態と管理
  • 4.3.1 ラステリ手術
  • 4.3.2 完全大血管転換症
  • 4.3.2.1 心房位血流転換
  • 4.3.2.2 ジャテン型手術
  • 4.3.3 その他
  • 4.4 術後に共通な問題とその管理
  • 4.4.1 感染性心内膜炎
  • 4.4.2 先天性心疾患母体の妊娠出産
  • 4.4.2.1 正常での妊娠中の血行動態変化
  • 4.4.2.2 先天性心疾患母体の妊娠出産
  • 4.4.2.3 管理
  • 5. Double switch手術
  • 5.1 はじめに
  • 5.2 対象と方法
  • 5.2.1 対象
  • 5.2.2 方法
  • 5.2.3 術式
  • 5.3 結果
  • 5.4 考察
  • 5.5 おわりに
  • 第7章 心不全と心筋・心膜疾患の最新治療
  • 1. 心筋炎
  • 1.1 はじめに
  • 1.2 急性心筋炎の臨床的特長
  • 1.2.1 臨床症状
  • 1.2.2 検査所見
  • 1.2.2.1 胸部X線
  • 1.2.2.2 心電図
  • 1.2.2.3 心エコー図
  • 1.2.2.4 検体検査
  • 1.2.2.5 心筋シンチ検査
  • 1.2.2.6 冠動脈造影と心内膜心筋生検
  • 1.2.2.7 ウイルス検索
  • 1.3 治療
  • 1.3.1 薬物治療
  • 1.3.2 補助循環法
  • 1.3.2.1 経皮的心肺補助(PCPS)の適応
  • 1.3.2.2 PCPS導入
  • 1.3.2.3 PCPSの管理
  • 1.3.2.4 PCPSの離脱
  • 1.3.3 ステロイド療法
  • 1.3.4 新しい試み(免疫調節療法・抗ウイルス剤・免疫グロブリン療法)
  • 1.4 おわりに
  • 2. 拡張型心筋症の内科的治療
  • 2.1 はじめに
  • 2.2 拡張型心筋症の薬物療法
  • 2.2.1 ジギタリス、強心薬
  • 2.2.2 利尿薬
  • 2.2.3 β受容体遮断薬
  • 2.2.4 アンジオテンシン変換酵素(ACE)阻害薬
  • 2.2.5 アンジオテンジン(AT)受容体拮抗薬
  • 2.2.6 アミオダロン
  • 2.2.7 Ca拮抗薬
  • 2.3 拡張型心筋症の非薬物療法
  • 2.3.1 ペーシング療法(resynchronization therapy)
  • 2.3.2 免疫吸着(immunoadsorption)療法
  • 2.4 今後の展望
  • 3. 感染性心内膜炎
  • 3.1 はじめに
  • 3.2 患者背景と起炎菌
  • 3.3 症状と診断
  • 3.4 治療
  • 3.4.1 化学療法
  • 3.4.2 手術適応
  • 3.4.3 人工弁感染
  • 3.4.4 外科治療
  • 3.5 予防
  • 4. 左室部分切除術及び新しいデバイス
  • 4.1 はじめに
  • 4.2 左室部分切除術の概念
  • 4.3 左室部分切除術の適応
  • 4.4 左室部分切除術の手術手技
  • 4.5 左室部分切除術のCleveland Clinicにおける手術成績
  • 4.6 左室部分切除術の他の施設における手術成績
  • 4.7 左室部分切除術の問題点
  • 4.8 Myocor Myosplint及びAcorn Cardiac Support Device
  • 4.9 まとめ
  • 5. 重症心不全治療Batista手術とDor手術
  • 5.1 はじめに
  • 5.2 Batista手術
  • 5.2.1 手術法
  • 5.2.2 手術のための左室検査法
  • 5.2.3 僧帽弁閉鎖不全に対する術式の選択
  • 5.3 Dor手術
  • 5.3.1 手術法
  • 5.3.2 手術適応
  • 5.4 手術成績
  • 5.4.1 非虚血性心筋症
  • 5.4.2 虚血性心臓病にたいする左室形成術
  • 5.5 考察
  • 5.6 おわりに
  • 第8章 不整脈の最新治療
  • 1. 洞不全症候群
  • 1.1 定義(概念)
  • 1.2 分類
  • 1.3 症状
  • 1.4 機序
  • 1.5 原因
  • 1.6 誘因
  • 1.7 診断、治療のための検査
  • 1.8 救急治療
  • 1.9 経口薬物治療
  • 1.10 ペースメーカー治療
  • 1.11 頻脈に対する治療
  • 1.12 抗凝固療法
  • 1.13 ペースメーカー治療に伴う合併症
  • 1.14 予後
  • 1.15 ペースメーカー機器の進歩と今後の展望
  • 2. 早期興奮症候群
  • 2.1 はじめに
  • 2.2 解剖&病理
  • 2.2.1 Atrioventricular Pathway(Kent束)
  • 2.2.2 Nodoventricular and Nodofascicular pathway variant
  • 2.2.3 Atriofascicular pathway
  • 2.2.4 Decremental atrioventricular pathway
  • 2.2.5 Concealed atrioventricular pathway
  • 2.2.6 Fasciculoventricular connections
  • 2.3 臨床症状、自然歴
  • 2.4 検査
  • 2.4.1 心電図
  • 2.4.2 心臓電気生理検査
  • 2.5 早期興奮症候群に伴う頻拍
  • 2.5.1 順行性房室回帰性頻拍(orthodromic AVRT)
  • 2.5.2 逆行性房室回帰性頻拍(antidromic AVRT)
  • 2.5.3 恒常型房室回帰性頻拍(permanent form of junctional reciprocating tachycardia: PJRT)
  • 2.5.4 房室結節回帰性頻拍
  • 2.5.5 心房細動、心房粗動
  • 2.5.6 心室頻拍
  • 2.6 検査の進め方、治療
  • 2.7 カテーテルアブレーション
  • 2.7.1 アプローチ
  • 2.7.2 電位
  • 2.7.3 固定
  • 2.7.4 成績、合併症
  • 2.7.5 アブレーションの今後
  • 3. 不整脈の外科治療
  • 3.1 はじめに
  • 3.2 心房細動の外科治療
  • 3.2.1 心房細動の病態
  • 3.2.2 心房細動の機序
  • 3.2.3 心房細動の手術適応
  • 3.2.3.1 孤立性心房細動に対するmaze手術
  • 3.2.3.2 他の心臓手術と同時に行うmaze手術
  • 3.2.4 心房細動の手術手技
  • 3.2.4.1 外科的房室ブロック作成術
  • 3.2.4.2 心房隔離術
  • 3.2.4.3 Corridor手術
  • 3.2.4.4 maze手術
  • 3.2.4.5 片側maze手術
  • 3.2.4.6 Compartment手術
  • 3.2.4.7 radial手術
  • 3.3 WPW症候群の外科治療
  • 3.3.1 WPW症候群の手術適応
  • 3.3.2 WPW症候群の手術手技
  • 3.4 房室結節回帰性頻拍の外科治療
  • 3.4.1 房室結節回帰性頻拍の手術適応
  • 3.4.2 房室結節回帰性頻拍の手術手技
  • 3.5 期外収縮の外科治療
  • 3.5.1 期外収縮の手術適応
  • 3.5.2 期外収縮の手術手技
  • 3.6 心室頻拍(VT)の外科治療
  • 3.6.1 心室頻拍(VT)の手術適応
  • 3.6.2 心室頻拍(VT)の手術手技
  • 3.7 心室細動(VF)に対する外科治療
  • 4. 突然死対策
  • 4.1 心臓性突然死の概念と頻度
  • 4.2 心臓性突然死と基礎疾患
  • 4.3 心臓性突然死の予知
  • 4.4 心臓性突然死の予防
  • 4.4.1 抗不整脈薬
  • 4.4.2 その他の薬剤
  • 4.4.3 植え込み型除細動器
  • 4.5 目撃者による蘇生術と体外式自動除細動器
  • 5. QT延長症候群
  • 5.1 はじめに
  • 5.2 遺伝性(先天性)QT延長症候群
  • 5.2.1 Romano-Ward症候群(LQT)
  • 5.2.2 Jervell and Lange-Nielsen症候群
  • 5.3 二次性QT延長症候群
  • 5.4 診断と検査
  • 5.4.1 診断
  • 5.4.2 心電図所見
  • 5.5 治療
  • 5.5.1 遺伝性QT延長症候群の治療
  • 5.5.2 二次性QT延長症候群の治療
  • 第9章 大動脈疾患の最新治療
  • 1. 胸腹部大動脈瘤
  • 1.1 はじめに
  • 1.2 Crawford分類
  • 1.3 手術
  • 1.3.1 麻酔および体位
  • 1.3.2 皮膚切開と術野の展開
  • 1.3.3 大動脈プレパレーション
  • 1.3.4 部分体外循環回路の設置
  • 1.3.5 人工血管置換術
  • 1.4 術後合併症と近接及び遠隔予後
  • 1.5 最新の研究と21世紀の展望
  • 1.5.1 脊髄障害の予防
  • 1.5.1.1 肋間動脈再建
  • 1.5.1.2 脊髄保護を目的とした補助手段の開発
  • 1.5.1.3 脊髄障害発生機序の研究と薬物的脊髄保護法
  • 1.5.2 21世紀の展望
  • 2. 逆行性脳灌流法とno-touch techniqueを用いた弓部再建術
  • 2.1 はじめに
  • 2.2 手術法
  • 2.3 手術成績
  • 2.4 まとめ
  • 3. 大動脈炎症候群
  • 3.1 はじめに
  • 3.2 概念とその変遷
  • 3.3 好発および病因
  • 3.4 病態
  • 3.5 病型
  • 3.6 臨床症状と所見
  • 3.7 診断
  • 3.8 内科的治療
  • 3.8.1 薬物療法
  • 3.8.2 非薬物療法
  • 3.9 本症の予後と今後の問題点
  • 4. 慢性大動脈解離に対する広範大動脈置換術
  • 4.1 はじめに
  • 4.2 手術適応
  • 4.3 治療戦略
  • 4.3.1 術前管理
  • 4.3.2 大動脈露出
  • 4.3.3 再建術式
  • 4.3.4 補助手段
  • 4.3.5 脊椎保護
  • 4.4 症例に学ぶ広範大動脈置換手術の実際
  • 4.5 手術成績
  • 4.6 おわりに
  • 5. 肺動脈血栓塞栓症
  • 5.1 はじめに
  • 5.2 治療に必要な病態の知識
  • 5.2.1 病態生理
  • 5.2.2 臨床上有意な肺血栓塞栓症
  • 5.2.3 肺梗塞の合併
  • 5.2.4 致死性急性肺血栓塞栓症
  • 5.2.5 急性と慢性の肺血栓塞栓症
  • 5.3 最新の内科的治療
  • 5.3.1 治療方針
  • 5.3.2 救急処置の概要
  • 5.3.3 血栓形成の新たな進展の防止
  • 5.3.4 積極的血栓溶解療法
  • 5.3.5 内科的塞栓除去術
  • 5.3.6 カテーテル肺血栓除去術(catheter pulmonary thrombectomy)
  • 5.4 急性肺動脈血栓塞栓症の外科的治療
  • 5.4.1 外科的塞栓除去術
  • 5.4.2 術前対策としてのPCPS
  • 5.5 急性肺動脈血栓塞栓症の1次予防
  • 5.5.1 1次予防の留意点
  • 5.5.2 DVTの予防とその危険因子
  • 5.5.3 薬物等による1次予防の実際
  • 5.5.4 一時的下大動脈フィルター(temporary vena caval filter)の使用
  • 5.6 急性肺動脈血栓塞栓症の2次予防
  • 5.6.1 2次予防の留意点
  • 5.6.2 下大静脈フィルター遮断法
  • 5.7 血栓溶解療法をめぐる問題点
  • 5.7.1 急性肺血栓塞栓症は自然に溶解するか
  • 5.7.2 急性肺血栓塞栓症に関する論点
  • 5.7.3 血栓溶解療法の現況
  • 5.8 慢性マイクロ血栓塞栓性肺高血圧症(TPH)に対する外科治療
  • 5.8.1 疾患概念
  • 5.8.2 治療の概略
  • 5.9 慢性マイクロTPHの手術適応の決定
  • 5.9.1 鑑別診断の要点
  • 5.9.2 肺血流シンチグラム
  • 5.9.3 肺動脈造影所見
  • 5.9.4 肺血管内視鏡と肺血管内エコー法
  • 5.10 画期的な外科的手術による治療
  • 5.10.1 両肺血栓内膜除去術
  • 5.10.2 術後の合併症とその病態
  • 5.11 おわりに
  • 第10章 画像診断の進歩
  • 1. 心エコー・ドプラ法
  • 1.1 はじめに
  • 1.2 心エコー検査の種類
  • 1.3 探触子を置く位置(アプローチ)
  • 1.4 断層心エコー図の基本断面(アプローチ別)
  • 1.5 心エコー検査施行に必要な基礎知識
  • 1.6 正常値
  • 1.7 簡易ベルヌーイ式
  • 1.8 弁狭窄の評価法
  • 1.9 弁逆流の評価法
  • 1.10 ハーモニックイメージング法
  • 1.11 コントラスト心エコー法
  • 1.12 ドブタミン負荷心エコー法
  • 1.13 左室収縮能評価法
  • 1.14 左室拡張能評価法
  • 1.15 組織ドプラ法
  • 1.16 ポータブル心エコー装置
  • 2. 血管内超音波法
  • 2.1 はじめに
  • 2.2 血管内超音波法の基礎
  • 2.2.1 血管内超音波カテーテルの種類
  • 2.2.2 画像解析
  • 2.2.3 画像のオリエンテーション
  • 2.3 インターベンションへの応用
  • 2.3.1 インターベンション前の評価
  • 2.3.2 インターベンション後の評価(非ステント療法)
  • 2.3.3 インターベンション後の評価(ステント療法)
  • 2.3.4 インターベンション後慢性期の評価
  • 2.4 血管内超音波法の将来
  • 2.4.1 ガイドワイヤー型IVUS(Imaging guidewire)
  • 2.4.2 三次元表示
  • 2.4.3 自動計測法(Automated contour detection)
  • 2.4.4 治療用カテーテル
  • 2.5 おわりに
  • 3. CT (マルチスライスCTを中心に)
  • 3.1 はじめに
  • 3.2 装置
  • 3.3 方法
  • 3.3.1 心電図同時記録スキャン法とハーフ再構成法
  • 3.3.2 心電図同時記録ダイナミックスキャン法と心電図同期ハーフ再構成法
  • 3.3.3 心電図同時記録ヘリカルスキャン法と心電図同期再構成法
  • 3.3.4 造影法
  • 3.3.5 表示法と解析法
  • 3.4 適応
  • 3.4.1 冠動脈の評価
  • 3.4.2 虚血性心疾患
  • 3.4.3 その他
  • 3.5 限界と将来
  • 4. 心臓核医学における新技術とその臨床的意義
  • 4.1 はじめに
  • 4.2 心筋血流診断の充実
  • 4.2.1 99mTc標識心筋血流製剤の利用
  • 4.2.2 多検出器型SPECT装置の普及
  • 4.2.3 PETによる局所心筋血流量の計測
  • 4.3 心機能計測の高精度化―心電図同期心筋血流SPECTの利用
  • 4.4 心筋生化学画像診断の導入―新しい診断分野の開拓
  • 4.4.1 123I-BMIPPによる心筋脂肪酸代謝イメージング
  • 4.4.2 18F-FDG像のSPECT装置による撮像
  • 4.4.3 123I-MIBGによる心臓交感神経イメージング
  • 4.5 21世紀の新しい課題
  • 第11章 医療材料、治療機器の進歩
  • 1. Tissue Engineering
  • 1.1 はじめに
  • 1.2 基礎的研究の進歩
  • 1.2.1 細胞培養法の進歩
  • 1.2.2 ポリマーの進歩
  • 1.2.3 発生工学の分野での進歩
  • 1.3 臨床的研究の進歩
  • 1.3.1 皮膚
  • 1.3.2 軟骨
  • 1.3.3 骨
  • 1.3.4 神経
  • 1.3.5 膵島
  • 1.3.6 心臓弁
  • 1.3.7 血管
  • 1.3.8 刺激伝導系
  • 1.4 おわりに
  • 2. ペースメーカー
  • 2.1 緒言
  • 2.2 ペースメーカーの原理と構造
  • 2.3 不整脈の種類とペーシング適応
  • 2.4 ペーシング様式との種類の適応
  • 2.4.1 AAI, VVIペーシング
  • 2.4.2 DVI, DDIペーシング
  • 2.4.3 VAT, VDDペーシング
  • 2.4.4 DDDペーシング
  • 2.5 生理的ペーシング
  • 2.6 レート応答ペーシング
  • 2.6.1 各種センサーの特徴
  • 2.6.2 閉鎖回路センサー(closed loop sensor)
  • 2.7 自動制御ペースメーカー
  • 2.8 心不全に対するペーシング治療
  • 2.8.1 DDDペースメーカー(dual chamber pacing)
  • 2.8.2 両心室ペーシング(biventricular pacing)
  • 2.9 抗不整脈効果が期待される新しいペーシング治療
  • 2.10 結語
  • 3. 人工心臓弁
  • 3.1 序論―現状と展望
  • 3.2 大動脈弁位ステントレス生体弁
  • 3.2.1 Medtronic Freestyle弁
  • 3.2.2 Tronto SPV弁
  • 3.3 ステントレス生体弁によるAVR術後の評価
  • 3.4 僧帽弁位ステントレス生体弁SJM QuatroTM Valve
  • 3,5 機能的向上をめざした新しい機械弁
  • 3.5.1 Sorin BICARBON弁
  • 3.6 おわりに
  • 4. 体内埋設型補助人工心臓
  • 4.1 はじめに
  • 4.2 体内埋設型拍動型補助人工心臓
  • 4.2.1 Novacor LVAS
  • 4.2.2 HeartMate LVAS
  • 4.2.3 完全体内埋設型拍動型ポンプ
  • 4.3 体内埋設型ロータリーポンプ
  • 4.3.1 体内埋設型軸流ポンプ
  • 4.3.2 体内埋設型遠心ポンプ
  • 4.4 今後の展望及び総括
  • 5. 植込み型除細動器
  • 5.1 はじめに
  • 5.2 ICDの構造と機能
  • 5.3 ICDの適応
  • 5.4 抗頻拍ペーシング
  • 5.5 臨床成績
  • 5.6 ICDの問題点
  • 5.6.1 合併症
  • 5.6.2 抗不整脈薬治療の併用
  • 5.7 おわりに
  • 第12章 薬剤開発に関する最新情報
  • 1. 強心薬
  • 1.1 はじめに
  • 1.2 新しい強心薬による臨床試験の問題点
  • 1.3 うっ血性心不全の治療と強心薬
  • 1.4 新しい強心薬による薬物療法
  • 1.4.1 Caセンシタイザー
  • 1.4.2 その他の新しい強心薬
  • 1.5 おわりに
  • 2. 血管拡張薬
  • 2.1 はじめに
  • 2.2 ARB
  • 2.2.1 テルミサルタン(telmisartan)
  • 2.2.2 イルベサルタン(irubesartan)
  • 2.2.3 オルメサルタン(olmesartan)
  • 2.3 Ca拮抗薬
  • 2.3.1 L型+T型Caチャネル拮抗薬
  • 2.3.2 その他のL型+T型Ca拮抗薬
  • 2.4 中性エンドペプチダーゼ阻害薬
  • 2.4.1 アラドリル(aladotril)
  • 2.4.2 オマパトリラート(omapatrilat)
  • 2.5 エンドセリン受容体拮抗薬
  • 3. β遮断薬
  • 3.1 はじめに
  • 3.1.1 βアドレナリン受容体の発見
  • 3.1.2 β受容体のシグナル伝達機構
  • 3.1.3 β1受容体とβ2受容体の分類
  • 3.2 β遮断薬開発の歴史
  • 3.2.1 β遮断薬開発のはじまり
  • 3.2.2 プロプラノロールの開発
  • 3.2.3 内因性交感神経活性(ISA)を有するβ遮断薬の開発
  • 3.2.4 β1選択性β遮断薬の開発
  • 3.2.5 β遮断薬の適応の拡大
  • 3.2.6 αβ遮断薬の開発
  • 3.3 β遮断薬の付加的作用
  • 3.3.1 抗酸化作用
  • 3.3.2 心筋に対する付加作用
  • 3.3.2.1 膜安定化作用(MSA)
  • 3.3.2.2 心筋保護作用
  • 3.3.3 血管に対する付加作用
  • 3.3.3.1 血管拡張作用
  • 3.3.3.2 抗動脈硬化作用
  • 3.3.4 甲状腺ホルモンに対する作用
  • 3.3.5 その他の付加的作用
  • 3.4 β遮断薬の開発状況
  • 3.4.1 β遮断薬の世代別分類
  • 3.4.2 日本で開発されたβ遮断薬
  • 3.4.3 β遮断薬と利尿薬の配合薬の開発
  • 3.4.4 新しいβ遮断薬ランジオロール
  • 3.5 おわりに
  • 4. 抗凝固薬と抗血小板薬
  • 4.1 はじめに
  • 4.2 抗凝固薬
  • 4.2.1 ヘパリン
  • 4.2.2 低分子ヘパリン
  • 4.2.3 ワルファリン
  • 4.2.4 選択的抗トロンビン薬及びその他
  • 4.3 抗血小板薬
  • 4.3.1 アスピリン
  • 4.3.2 チクロピジン
  • 4.3.3 シロスタゾール
  • 4.3.4 ジピリダモール
  • 4.3.5 トラジピル
  • 4.3.6 GP IIb/IIIa拮抗薬
  • 5. 抗不整脈薬
  • 5.1 はじめに
  • 5.2 心筋Kチャネルの種類と機能
  • 5.2.1 心筋活動電位とKチャネル
  • 5.2.2 Kチャネルの分子構造と遺伝子
  • 5.3 抗不整脈薬のKチャネル遮断作用
  • 5.4 現在開発中のIII群薬
  • 5.4.1 イブチリド(ibutilide)
  • 5.4.2 ドフェチリド(dofetilide)
  • 5.4.3 アジミリド(azimilide)
  • 5.4.4 ドロネダロン(dronedarone, SR-33589)
  • 5.5 おわりに
  • 6. 抗高脂血症薬
  • 6.1 高脂血症の薬物療法の基本
  • 6.2 高コレステロール血症診療のガイドライン
  • 6.3 高コレステロール血症薬物療法の実際
  • 6.3.1 主としてコレステロールを低下する薬剤
  • 6.3.2 主としてトリグリセライドを下げる薬剤
  • 6.3.3 コレステロール低下療法の長期効果
  • 6.4 強力なコレステロール低下療法と冠動脈疾患のインターベンションの比較試験
  • 6.5 おわりに
  • 第13章 各種製品の臨床評価
  • 1. 低侵襲心臓手術に用いる手術器具―Cosgrove Flex Clamp―
  • 1.1 はじめに
  • 1.2 MICSの工学的支援
  • 1.3 Port-Access手術時の大動脈遮断法
  • 1.4 おわりに
  • 2. 低侵襲心臓手術に用いる新しい手術器具―chitwood sliding clamp, MIC sternum rake―
  • 2.1 はじめに
  • 2.2 Chitwoodの経胸壁的Sliding大動脈遮断鉗子
  • 2.3 MICS sternum rake(胸骨鈎: くま手)
  • 3. 心保護薬としてのテノーミン・セロケンの役割
  • 3.1 はじめに
  • 3.2 アテノロール・メトプロロールの薬理学的特性
  • 3.2.1 β1選択性について
  • 3.2.2 内因性交感神経刺激作用(ISA)について
  • 3.2.3 脂溶性・水溶性、薬物動態について
  • 3.3 アテノロール・メトプロロールの心保護効果
  • 3.3.1 高血圧症
  • 3.3.2 狭心症
  • 3.3.3 心筋梗塞
  • 3.3.4 拡張性心筋症
  • 3.3.5 心不全
  • 3.3.6 不整脈
  • 3.4 まとめ
  • 4. 心不全治療薬「アカルディ」
  • 4.1 はじめに
  • 4.2 pimobendanの慢性心不全患者に対する臨床効果
  • 4.2.1 運動耐容能・症状改善作用
  • 4.2.2 心事故抑制作用
  • 4.3 pimobendanの具体的使用方法
  • 4.4 おわりに
  • 5. 長時間カルシウム拮抗薬「ノルバスク」
  • 5.1 はじめに
  • 5.2 薬理作用
  • 5.2.1 アムロジピンは長時間作用型の第3世代カルシウム拮抗薬である
  • 5.2.2 アムロジピンはユニークな分子構造と特性を有し、緩徐な作用発現と優れた作用持続性を有する
  • 5.3 臨床試験
  • 5.3.1 TOMHS: Treatment of Mild Hypertension Study
  • 5.3.2 CASIS: Canadian Amlodipine/Atenolol in Silent Ischemia Study
  • 5.3.3 CAPE: Circadian Anti-ischemia Program in Europe
  • 5.3.4 CAPE II: Circadian Anti-ischemia Program in Europe II
  • 5.3.5 CAPARES: Coronary AngioPlasty Amlodipine in REStenosis Study
  • 5.3.6 PREVENT: Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial
  • 5.3.7 PRAISE: Prospective Randomized Amlodipine Survival Evaluation
  • 5.3.8 PRAISE-2: Prospective Randomized Amiodipine Survival Evaluation-2
  • 5.4 副作用
  • 5.5 まとめ
  • 6. 「アルダクトンA」について
  • 6.1 はじめに
  • 6.2 アルドステロンと心不全
  • 6.3 スピロノラクトン(アルダクトンA)による心不全治療<RALES試験>
  • 6.4 米国心不全学会(HFSA)の新しい治療ガイドライン
  • 6.5 スピロノラクトンによる治療の意義
  • 7. 心不全治療における Phosphodiesterase-III (PDE-III) 阻害薬の臨床的位置づけ
  • 7.1 はじめに
  • 7.2 PDE-III阻害薬の構造・組成および性状
  • 7.3 PDE-III阻害薬の作用機序
  • 7.3.1 作用機序
  • 7.3.2 PDE-III阻害薬の作用
  • 7.3.3 PDE-III阻害薬の作用機序: ニトロプルシドおよびドブタミンとの相違
  • 7.3.4 PDE-III阻害薬の利点: カテコラミンとの比較
  • 7.4 PDE-III阻害薬の有効性が期待される病態
  • 7.4.1 収縮期血圧
  • 7.4.2 容量負荷所見の存在
  • 7.4.3 肺高血圧
  • 7.4.4 長時間にわたるカテコラミン投与がなされている症例
  • 7.4.5 虚血性心疾患に合併する心不全
  • 7.4.6 β遮断薬投与中に心不全を生じた症例
  • 7.5 PDE-III阻害薬の投与方法と投与用量
  • 7.5.1 併用投与
  • 7.5.1.1 利尿薬
  • 7.5.1.2 血管拡張薬
  • 7.5.2 単独投与
  • 7.6 PDE-III阻害薬投与における問題点とその対策
  • 7.6.1 腎障害合併例への投与
  • 7.6.2 PDE-III阻害薬の効果が得られない症例
  • 7.7 おわりに
  • 技術資料編
  • ハードとソフトを融合した新世代のコラートIABPシステム
  • 1 はじめに
  • 2 システム的な視点で開発したアイシン「コラートIABP」
  • 2.1 センサー付きバルーン
  • 2.2 予圧制御回路
  • 2.3 オートモード
  • 3 駆動装置モデル「コラート21」
  • 3.1 搬送性の向上
  • 3.2 管理のしやすさ
  • 3.3 バックアップモード
  • 4 今後めざす方向性
  • 持続的血液ろ過透析装置 JUN-505について
  • 1 はじめに
  • 2 JUN-505の開発経緯
  • 3 JUN-505の特徴
  • 4 JUNシリーズの計量方式
  • 5 おわりに
  • 弁形成用リング
  • 1 はじめに
  • 2 カーペンターエドワーズリング(クラシックリング)
  • 2.1 背景
  • 2.2 特徴
  • 2.3 臨床成績
  • 3 カーペンターエドワーズフィジオリング
  • 3.1 背景
  • 3.2 特徴
  • 3.3 臨床成績
  • 4 コスグローブエドワーズ人工弁輪
  • 4.1 背景
  • 4.2 特徴
  • 4.3 臨床成績
  • 5 拡張型心筋症および虚血性疾患へのリングの適応
  • 新しい二葉弁: On-X(R)バルブ
  • 1 はじめに: パイロライトカーボン弁の歴史
  • 2 On-Xバルブの特徴
  • 3 On-Xバルブの水力学的特性
  • 4 まとめ
  • 連続心拍出量測定装置Picco
  • 1 はじめに
  • 2 測定機器類のセッティング
  • 3 圧波形解析による心拍出量の連続測定
  • 4 経動脈的熱希釈法
  • 5 まとめ
  • 超音波診断装置アジレントテクノロジー社製SONOS5500
  • 1 はじめに
  • 2 AD(Acoustic Densitometory)機能
  • 3 AQ(Acoustic Quntification)機能
  • 4 CK(Color Kinesis)機能
  • 5 コントラスト機能
  • 6 ストレス心エコー機能
  • 7 3D機能
  • ProSound II (SSD-6500)
  • 1 ProSoundシリーズ
  • 1.1 Digital Pure Imagingがコンセプト
  • 2 第2世代のProSound
  • 2.1.1 Ultra High Frame Rate
  • 2.1.2 Extended Pure Harmonic Detection
  • 2.2 Packaging Multi Function
  • 2.2.1 Real Time DOP Auto Trace
  • 2.2.2 A-SMA/CQ
  • 3 解析ツール(Prism)
  • 3.1 多彩なデータ保存形式
  • 3.2 インテリジェント解析
  • 3.2.1 Contrast Echo解析
  • 3.2.2 TDI解析
  • 3.2.3 Stress Echo解析
  • 3.2.4 BETA解析(Back Scattered Energy Temporal Analysis)
  • 3.2.5 保存データの計測・レポート
  • 4 拡張したデータコミュニケーション
  • 4.1 DICOM3.0に準拠したデータ管理
  • 4.2 HIS/RISともリンク可能
  • 5 今後の展望
  • イマトロン社製 電子ビームCT「EBT」
  • 1 はじめに
  • 2 EBT装置と主な仕様
  • 3 EBTによるイメージングとFDA
  • 3.1 心臓イメージング
  • 3.2 ボディイメージング
  • 3.3 最近のFDA501(k)承認
  • 4 EBT臨床応用
  • 4.1 EBTガイドライン
  • 4.2 EBA(Electron Beam Angiography)
  • 4.3 冠状動脈石灰化検査(CAC)
  • 4.4 低線量肺スキャン
  • 5 おわりに
  • ELK Angio Systemシリーズ循環器動画像運用ネットワークシステム ELK Card-on-net
  • 1 はじめに
  • 1.1 ELK Cardi-on net
  • 1.2 デジタルシネアンギオプロジェクター DCAP-II
  • 携帯型超音波の技術革新と今後の展望
  • 1 はじめに
  • 2 携帯型超音波診断装置開発の歴史
  • 3 第1世代携帯型超音波診断装置の開発
  • 4 第2世代携帯型超音波診断装置の開発
  • 5 携帯型超音波の将来ビジョン
  • フラットパネルディテクタ搭載心血管撮影装置INNOVA2000の展望
  • 1 はじめに
  • 2 開発の経緯
  • 2.1 開発の目標
  • 2.2 検出器概略
  • 2.3 間接変換方式の採用
  • 2.4 広範なダイナミックレンジ
  • 2.5 線量管理
  • 3 臨床評価
  • 4 おわりに
  • 循環器超音波定量診断技術 (QTVI)
  • 1 はじめに
  • 2 QTVI(Quantitative Tissue Velocity Imaging)の原理
  • 3 QTVIでは何がわかるか
  • 3.1 左室全体の機能評価・局所壁運動評価が可能
  • 3.2 任意方向、任意曲線のAnatomical M-modeによる伝播時相の描出
  • 3.3 壁厚増加率による伸縮機能の評価
  • 3.4 ストレスエコーへの応用
  • 3.5 刺激伝導系の精査・検索への応用
  • 4 QTVIの制限とは
  • 心筋コントラストエコー最新の話題 定量化への新たなる試み
  • 1 はじめに
  • 2 コントラスト解析
  • 2.1 時間―輝度曲線(トリガーモード)
  • 2.2 時間―輝度曲線(リアルタイム)
  • 2.3 Curved Anatomical M-Mode
  • 3 おわりに
  • 心血管造影透視・撮影に伴う被曝低減
  • 1 はじめに
  • 2 C.A.R.E.プログラム
  • 2.1 CAREフィルタ
  • 2.2 CAREプロファイル
  • 2.3 CAREビジョン
  • 2.4 CAREグラフ
  • 3 おわりに
  • 心血管疾患の早期検出手段としてのシーメンスマルチスライスCT技術
  • 1 はじめに
  • 2 心血管疾患
  • 3 冠動脈石灰化の定量性
  • 4 不整脈患者への応用
  • 5 冠動脈のCTアンギオグラフィ
  • 6 CTの分解能
  • 7 最後に
  • 心筋血流製剤・カーディオライト (99mTc-MIBI)
  • 1 はじめに
  • 2 集積機序
  • 3 検査方法
  • 4 心筋虚血の診断
  • 5 予後評価
  • 6 心機能心筋血流の同時評価
  • 6.1 ファーストパスRIアンギオグラフィ法
  • 6.2 心電図同期SPECT法
  • 7 まとめ
  • 非イオン性尿路・血管造影剤 イオパミロン(R)
  • 1 はじめに
  • 2 製品の特性
  • 2.1 尿路・血管造影剤
  • 2.2 製剤
  • 3 臨床
  • 3.1 非イオン性造影剤の安全性
  • 3.2 心臓血管撮影における副作用
  • 3.3 腎への影響
  • 3.4 透析患者への使用
  • 3.5 副作用対策
  • 3.6 イオパミロンと心臓領域の血管撮影
  • 99mTc標識心筋血流製剤マイオビュー(R)
  • 1 はじめに
  • 2 マイオビューの特徴
  • 3 マイオビューによる各種検査プロトコール
  • 3.1 安静先行型短時間プロトコール
  • 3.2 負荷一回法にによるスクリーニングプロトコール
  • 3.3 マイオビュー/201TIによる2核種併用プロトコール
  • 4 心電図同期SPECTの利用
  • 5 むすび
  • レムナント様リポ蛋白コレステロール (RLP-C) ―冠動脈疾患患者の冠イベント予測因子として―
  • 1 はじめに
  • 2 開発の経緯
  • 3 RLP-C測定法
  • 4 キットの特徴
  • 5 冠動脈疾患におけるRLP-C測定の臨床的意義
  • 6 冠動脈疾患患者の冠イベント予測因子
  • 7 おわりに
  • 急性心筋梗塞診断の生化学マーカー "H-FABP" について
  • 1 はじめに
  • 2 H-FABPについて
  • 3 AMIの早期診断
  • 4 AMI再疎通の確認
  • 5 梗塞サイズの定量
  • 6 AMI以外の疾患におけるH-FABP
  • 7 開胸手術における心筋傷害判定
  • 8 H-FABP測定系について
  • 9 H-FABP測定における注意点
  • 10 おわりに
  • 原発性肺高血圧症治療薬、プロスタグランジンI2注射製剤について
  • 1 開発の経緯
  • 2 薬理学的特徴
  • 3 国内臨床試験
  • 4 在宅医療
  • 5 適用時の注意事項
  • 6 持続静脈内投与継続による効果
  • 血管拡張性β遮断薬 ハイパジールコーワ錠をとりまく最近の話題
  • 1 はじめに
  • 2 特徴
  • 3 ハイパジールコーワ錠のインスリン感受性改善効果
  • 4 高血圧症患者のQOLに及ぼす臨床評価
  • 5 まとめ
  • リポ蛋白代謝改善剤: リポクリン(R)
  • 1 はじめに
  • 2 特徴
  • 2.1 構造
  • 2.2 製剤
  • 2.3 効能・効果と用法・用量
  • 2.4 生体内動態
  • 2.5 臨床効果
  • 2.5.1 全般改善度
  • 2.5.2 血清脂質に対する作用
  • 2.5.2.1 血清総コレステロール低下作用
  • 2.5.2.2 血清トリグリセライド(TG)低下作用
  • 2.5.2.3 HDL-コレステロール(HDL-C)増加作用
  • 2.5.3 黄色腫の退縮作用
  • 2.5.4 血小板凝集能の改善作用
  • 2.5.5 胆石形成能に対する作用
  • 2.5.6 長期投与の影響
  • 2.5.7 副作用
  • 2.6 作用機序
  • 2.6.1 血清脂質低下作用
  • 2.6.1.1 肝でのTG及びVLDLの合成抑制作用
  • 2.6.1.2 リポ蛋白リパーゼ(LPL)活性亢進による血清TGの処理促進作用
  • 2.6.1.3 LDL受容体活性の亢進
  • 2.6.2 HDL機能の亢進作用
  • 2.6.3 血管壁細胞内コレステロールの代謝改善作用
  • 3 おわりに
  • 急性心不全治療薬「ハンプ(R)注射用 1000」
  • 1 はじめに
  • 2 新しい急性心不全の治療概念
  • 3 製品概要
  • 3.1 構造
  • 3.2 効能・効果、用法・用量
  • 3.3 作用機序
  • 3.3.1 血管拡張作用
  • 3.3.2 利尿作用
  • 3.4 製品の特性
  • 3.4.1 用量反応性
  • 3.4.2 呼吸困難改善効果
  • 3.4.3 神経体液因子抑制作用
  • 4 最近の臨床研究
  • 5 今後の展望
  • 持続性ACE阻害薬ペリンドプリル
  • 1 はじめに
  • 2 ペリンドプリルの薬理学的特徴
  • 3 ペリンドプリルの臨床効果
  • 3.1 降圧効果と持続性
  • 3.2 大動脈コンプライアンスおよび血管リモデリング改善作用
  • 4 ACE阻害剤とAII受容体拮抗薬
  • 5 おわりに
  • Nicorandilの心筋保護効果について
  • 1 はじめに
  • 2 Nicorandilの心筋保護作用
  • 3 心筋組織への移行および代謝
  • 4 まとめ
  • ループ利尿薬トラセミド (ルプラック(R))
  • 1 はじめに
  • 2 薬理作用
  • 2.1 正常動物に対する利尿作用
  • 2.2 心不全動物に対する利尿作用および浮腫改善作用
  • 2.3 腎不全動物に対する利尿作用
  • 3 作用機序
  • 3.1 ループ利尿作用
  • 3.2 抗アルドステロン作用
  • 4 臨床試験成績
  • 5 おわりに
  • 不整脈・狭心症治療薬: ベプリコール (塩酸ベプリジル)
  • 1 はじめに
  • 2 薬理作用
  • 2.1 細胞膜における作用
  • 2.2 細胞内における作用
  • 3 薬物動態
  • 3.1 吸収
  • 3.2 代謝
  • 3.3 排泄
  • 4 臨床成績
  • 4.1 頻脈性不整脈(心室性)
  • 4.2 狭心症
  • 4.3 安全性
  • 5 まとめ
  • 新しい急性心不全治療剤アデール(R)注
  • 1 はじめに
  • 2 薬効薬理
  • 2.1 陽性変力作用及び血管拡張作用
  • 2.2 実験的心不全に対する作用
  • 3 薬物動態
  • 3.1 血漿中濃度
  • 3.2 代謝・排泄
  • 4 効能・効果と用法・用量
  • 5 臨床試験成績
  • 6 副作用
  • 7 相互作用
  • 8 製剤
  • 9 おわりに
  • III群不整脈治療剤 シンビット(R)注
  • 1 はじめに
  • 2 薬理作用
  • 3 適応
  • 4 使用方法
  • 5 体内薬物動態
  • 6 臨床成績
  • 6.1 心室頻拍停止・再発抑制効果
  • 6.2 安全性
  • 7 使用上の注意
  • 8 おわりに
  • 急性心不全治療剤アムコラル(R)注射液50・100
  • 1 はじめに
  • 2 薬効薬理
  • 2.1 作用部位・作用機序
  • 2.2 効力を裏付ける試験成績
  • 2.2.1 強心作用
  • 2.2.2 血管拡張作用
  • 2.2.3 実験的心不全に対する作用
  • 2.2.4 心筋代謝に対する作用
  • 2.2.5 心臓刺激伝導系に及ぼす電気生理学的作用
  • 3 薬物動態
  • 3.1 血中濃度
  • 3.1.1 単回静脈内投与した場合
  • 3.1.2 静脈内投与後に点滴静脈内投与した場合
  • 3.1.3 蛋白結合
  • 3.2 代謝
  • 3.3 排泄
  • 4 臨床成績
  • 4.1 臨床試験
  • 4.2 市販後使用成績調査の結果
  • 5 製剤
  • 5.1　組成
  • 5.2 製剤の性状
  • 6 効能・効果
  • 7 用法・用量
  • 8 おわりに
  • 企業一覧
  • 索引
  • 奥付

この書籍の参考文献

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本参考文献は電子書籍掲載内容を元にしております。

序章

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第1章 心臓病診断の21世紀への展望

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第2章 心臓病の分子生物学

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第3章 臓器移植と再生

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17) Scorsin M, Hagege AA, Dolizy I et al:Can cellular transplantation improve function in doxorubicin-induced heart failure? Circulation;98 (19 Suppl):II 151-II 155, 1998
 
18) Yoo KJ, Li RK, Weisel RD et al:Heart cell transplantation improves heart function in dilated cardiomyopathic hamsters. Circulation;102 (19 Suppl 3):III 204-III 209, 2000
 
19) Atkins BZ, Hueman MT, Meuchel J et al:Cellular cardiomyoplasty improves diastolic properties of injured heart. J Surg Res;85 (2):234-242, 1999
 
20) Li RK, Jia ZQ, Weisel RD et al:Survival and function of bioengineered cardiac grafts. Circulation;100 (19 Suppl):1163-1169, 1999
 
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7) Tomita S, Li R, Weisel R et al:Autologous transplantation of bone marrow cells improves damaged heart function. Circulation 100:II-247-256, 1999
 
8) Vincent K, Shyu K, Luo Y et al:Angiogenesis is induced in a rabbit model of hindlimb ischemia by naked DNA encoding an HIF-1α/V16 hybrid transcription factor. Circulation 102:2255-2261, 2000
 
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第4章 冠動脈疾患の最新治療

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第5章 弁膜疾患の最新治療

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第6章 先天性心疾患の最新治療

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52) 太田真弓,篠原徳子,富松宏文ほか:成人期の先天性心疾患-妊娠,出産における母児管理.日本小児循環器学会 13:194, 1997 (抄録)
 
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54) 千葉善英:妊娠と心疾患の管理,日本医師会雑誌 112:1717-1720, 1994
 
55) Buttar HS:An overview of the influence of ACE inhibitors on fetal-placental circulation and perinatal development. Mol Cell Biochem 176:61-71, 1997
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第7章 心不全と心筋・心膜疾患の最新治療

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3) McCarthy JF, McCarthy PM, Starling RC et al:Partial left ventriculectomy and mitral valve repair for end-stage congestive heart failure. Eur J Cardiothorac Surg 13:337-343, 1998
 
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5) 須磨久喜,磯村正,堀井泰浩ほか:重症心不全を伴う非虚血性心筋症に対する左室縮小形成術70例の経験.JCardiol 2001 (in press)
 
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9) Etoch SW, Koenig SC, Laureano MA et al:Results after partial left ventriculectomy versus heart transplantation for idiopathic cardiomyopathy. J Thorac Cardiovasc Surg 117:952-959, 1999
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14) Dickstein ML, Spotnitz HM, Rose EA et al:Heart reduction surgery:an analysis of the impact on cardiac function. J Thorac Cardiovasc Surg 113:1032-1040, 1997
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17) Cury PM, Higuchi ML, Gutierrez PS et al:Autopsy findingskmearly and late postoperative death after partial left ventriculectomy. Ann Thorac Surg 69:769-773, 2000
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18) McCarthy PM, Fukamachi K, Takagaki M et al:Device based left ventricular shape change:anew concept for the treatment of dilated cardiomyopathy. J Thorac Cardiovasc Surg (in press)
 
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3) Isomura T, Suma H, Horii T et al:Prtial left ventriculectomy, ventriculoplasty or valvular surgery for idiopathic dilated cardiomyopathy-the role of intraoperative echography. Eur J Cardio-thorac Surg 17:239-45, 2000
 
4) Stoney WS, Alfod WC Jr et al:Repair of anteroseptal ventricular aneurysm. Ann Thorac Surg 15:394-8, 1973
 
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8) Yamaguchi A, Ino T, Adachi H, et al:Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy. Ann Thorac Surg 65:434-38, 1998
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9) 須磨久善,磯村 正,堀井泰浩,ほか:拡張型心筋症に対する左室縮小形成術 (Batista手術) の早期成績.JCardiolo 31:83-90, 1998
 
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17) Bolling SF, et al:Intermediate term outcome of mitral reconstruction in cardiomyopathy, J Thorac Cardiovasc Surg 115:381-386, 1998
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第8章 不整脈の最新治療

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第9章 大動脈疾患の最新治療

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第10章 画像診断の進歩

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第11章 医療材料、治療機器の進歩

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第12章 薬剤開発に関する最新情報

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第13章 各種製品の臨床評価

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