大阪暁明館病院心臓血管病センターの診療、活動内容
卓越した専門家集団
診療、研究、教育を民間病院にいながら少人数でコンパクトに行ってきました。
論文や症例報告もベテランの先生方が指導して皆ふつうに書いています。ACC、AHA、日本循環器病学会その他学会では、常に新しい知見を発表しています。
国内外から見学の先生方が来られています。
常識にとらわれない、はやりに惑わされない
診療にもはやりすたりがあります。それを追いかけて昨日と真逆のことを「海外のエビデンス」などと傾向が変わったことは一つ二つ経験したことがあるでしょう。
なぜ、真逆のことがこれまでいいと思われてきたのか、では今度逆になるにはどういう背景があるか考えると、トレンドに流されないようになります。
基本の上に革新がある
医学を変える発見の余地はそこかしこにあります。それを見つける繰り返しを行い、今後どの分野に行っても考え方の基本を身につけることができます。
これからの医学すべてを網羅する鍵を持っています
冠動脈だけではなく、大動脈、そして動脈硬化、老化、認知症すべてが専門分野だというと、理屈ばかり述べ立てていると思うかもしれません。
これらの分野を実際深く考え、大きく常識を変える鍵を持っているのは我々です。
2022年3月 医師向けのテキストを出版しました
検査、治療法について
心エコー
頸動脈エコー、血管エコー
CT (Definition Flash, Siemens)：心臓CT、各種血管CT
MRI 1.5T
エルゴメーター
ホルター
24時間血圧計（ABPM)
ABI、TBI
心臓カテーテル検査
CAG、LVG、スワンガンズカテーテル検査
一時的ペーシング検査
血管内視鏡（大動脈、冠動脈）
IVUS
恒久的ペースメーカー植え込み術
カテーテルアブレーション
心臓循環器病理検索
コレステロール結晶の同定
その他
ZOOMによる全国のオピニオンリーダーの先生方との症例検討会
循環器カテーテルライブシステム
2017年からの論文です
Komatsu S, Ohara T, Takahashi S, Takewa M, Yutani C, Kodama K. Improving the Visual Field in Coronary Artery by with Non-obstructive Angioscopy: Dual Infusion Method. Int J Cardiovasc Imaging 2017 Jun;33(6):789-796.
Komatsu S, Takahashi S, Ohara T, Kodama K. Aortic Valve Stenosis and Atheromatous Ascending Aorta. Internal Medicine 2017 Oct 1;56(19):2685-2686.
Komatsu S, Takahashi S, Toyama Y, Kodama K. Angioscopy-guided Selective Aspiration Thrombectomy for Acute Pulmonary Thromboembolism. BMJ cases 2017
May 22;2017. pii: bcr-2017-220059. doi: 10.1136/bcr-2017-220059. PubMed PMID:
28536230.
Komatsu S, Takahashi S, Toyama Y, Kodama K. Exploring Inside a Shaggy Aorta Using Non-obstructive Angioscopy. BMJ cases 2017 May 22;2017. pii:
bcr-2017-219449. doi: 10.1136/bcr-2017-219449. PubMed PMID: 28536220.
Ueda Y, Hiro T, Hirayama A, Komatsu S, Matsuoka H, Takayama T, Ishihara M, Hayashi T, Saito S, Kodama K. Effect of Ezetimibe on Stabilization and Regression of Intracoronary Plaque: The ZIPANGU Study. Circ J 2017 Oct 25;81(11):1611-1619.
Murakami T, Komatsu S, Kodama K, Shibata T. Detection of vulnerable atherosclerotic plaque during thoracic endovascular aortic repair using nonobstructive angioscopy. Int Med Res 2018 Mar;46(3):1086-1090.
Toyama Y, Komatsu S, Takewa M, Kodama K. Angioscopic observation of an atherosclerotic coronary aneurysm without yellow plaque. BMJ Case Rep. 2017 Jul 24;2017.
Takewa M, Komatsu S, Takahashi S, Kodama K. Aortic Stent Graft Injury Over Active Blood Flow: Over the Fence. BMJ Case Rep i2018 Mar 18;2018. pii:bcr-2018-224812. doi: 10.1136/bcr-2018-224812. PubMed PMID: 29555810.
Komatsu S, Takahashi S, Takewa M, Kodama K. Subintimal Intraplaque Haemorrhage prior to Aortic Plaque Rupture: Two-year Angioscopic Follow-up. BMJ Case Rep 2018 Mar 28;2018. pii: bcr-2018-224801. doi: 10.1136/bcr-2018-224801. PubMed PMID:29593007.
Komatsu S, Yutani C, Ohara T, Takahashi S, Takewa M, Hirayama A, Kodama K. Angioscopic Evaluation of Spontaneously Ruptured Aortic Plaques. J Am Coll Cardiol 2018 Jun 26;71(25):2893-2902.
Takahashi S, Komatsu S, Takewa M, Kodama K. Demonstration of entry tear and disrupted intima in asymptomatic chronic thrombosed type B dissection with non-obstructive angioscopy. BMJ Case Reports Apr 24;2018. pii: bcr-2018-225268.
doi: 10.1136/bcr-2018-225268.
Yutani C, Nagano T, Komatsu S, Kodama K. Visible Free Cholesterol Crystal Emboli Adjacent to Micro-infarcts in Myocardial Capillaries and Arterioles on Haematoxylin-eosin-stained Frozen Sections of an Autopsied Patient BMJ Cases 2018 Jul 11;2018. pii: bcr-2018-225558. doi: 10.1136/bcr-2018-225558.
Takahashi S, Komatsu S, Ohara T, Takewa M, Toyama Y, Yutani C, Kodama K. Detecting Intimal Tear and Subintimal Blood Flow of Thrombosed Acute Aortic Dissection with Ulcer-Like Projections Using Non-obstructive Angioscopy. J Cardiology Cases 2018 Jul 17;18(5):164-167.
Shu Kasama, Tohru Masuyama, Shiro Uemura, Yukihito Sato, Shinya Hiramitsu, Izuru Masuda, Kazuhiro Yamamoto, Sei Komatsu, Toshihisa Anzai, Kunihiro Nishimura, Tomoya Ueda, Masato Kasahara, Hiroyuki Tanaka, Yutaka Susuta, Yoshihiko Saito. Rationale and Design of the CANONICAL Study - Randomized, Open-Label Study to Evaluate the Efficacy and Safety of Canagliflozin for Heart Failure With Preserved Ejection Fraction With Type 2 Diabetes Mellitus. Circulation Reports, 2019;1;347-351.
Komatsu S, Takahashi S, Yutani C, Ohara T, Takewa M, Hirayama A, Kodama K. Spontaneous Ruptured Aortic Plaques and Injuries Detected using Non-obstructive General Angioscopy. Journal of Coronary Artery Disease 2019, 25,65-69.
Bhatt DL, Steg PG, Mehta SR, Leiter LA, Simon T, Fox K, Held C, Andersson M,
Himmelmann A, Ridderstråle W, Chen J, Song Y, Diaz R, Goto S, James SK, Ray KK,
Parkhomenko AN, Kosiborod MN, McGuire DK, Harrington RA; THEMIS Steering
Committee and Investigators. Ticagrelor in patients with diabetes and stable
coronary artery disease with a history of previous percutaneous coronary
intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial.
Lancet. 2019 Sep 28;394(10204):1169-1180.
Steg PG, Bhatt DL, Simon T, Fox K, Mehta SR, Harrington RA, Held C, Andersson
M, Himmelmann A, Ridderstråle W, Leonsson-Zachrisson M, Liu Y, Opolski G,
Zateyshchikov D, Ge J, Nicolau JC, Corbalán R, Cornel JH, Widimský P, Leiter LA;
THEMIS Steering Committee and Investigators. Ticagrelor in Patients with Stable
Coronary Disease and Diabetes. N Engl J Med. 2019 Oct 3;381(14):1309-1320.
Komatsu S, Yutani C, Takahashi S, Kodama K. Acute Myocardial Infarction due to Distal Embolization from a Proximal Ruptured Plaque. JACC Case Reports 2020;2:33-4.
Komatsu S, Takahashi S, Yutani C, Ohara T, Takewa M, Hirayama A, Kodama K. Spontaneous Ruptured Aortic Plaque and Injuries: Insights for Aging and Acute Aortic Syndrome from Non-obstructive General Angioscopy. J Cardiol. 2020 Apr;75(4):344-351.
Komatsu S, Yutani C, Takewa M, Takahashi S, Kodama K. Detecting Free Cholesterol Crystals in a Spontaneous Cholesterol Embolization Syndrome Patient. JACC Case Reports 2020 Apr, 2 (4) 615–618.
Takahashi S, Komatsu S, Yutani C, Takewa M, Ohara T, Kodama K. Detection of Spontaneous Subintimal Hemorrhage Using Angioscopy 1 Year before Acute Aortic Dissection. Circ J 2020:84;678.
Nishi H, Higuchi Y, Domae K, Inoguchi K, Kawasumi R, Takahashi T, Hamanaka Y, Komatsu, S, Hirayama A, Kodama K. Aortic Angioscopy assisted Thoracic Endovascular Repair for Chronic type B Aortic Dissection. J Cardiol, 2020 Jul;76(1):60-65.
Higuchi Y, Hirayama A, Komatsu S, Kodama K. A case of embolic stroke caused by aortic ruptured plaque and thrombus visualized by angioscopy. JACC Case Reports 2020 2(5) 705-706.
Kobayashi T, Higuchi Y, Komatsu S, Yutani C, Hirayama A, Kodama K. Visualization of Cholesterol Crystals Liberated From a Diseased Saphenous Vein Coronary Bypass Graft. JACC Cardiovasc Interv. 2020 Jun 8;13(11):e105-e106.
Komatsu S, Takahashi S, Takewa M, Yutani C, Kodama K. Multiple Intimal Injuries of Chronic Aortic Dissection Observed by Non-Obstructive General Angioscopy. Circ Rep. 2021 Jan 8;3(2):112-113.
Komatsu S, Takahashi S, Yutani C, Takewa M, Ohara T, Kodama K, Dissolution of Spontaneous Thrombi Responsible for Acute Coronary Syndrome for 1 Year. Circ Rep, 2021 Aug 24;3(10):625-626.
Iwa N, Yutani C, Komatsu S, Takahashi S, Takewa M, Ohara T, Kodama K. Novel Methods for Detecting Human Cholesterol Crystals from Sampled Blood. Lab Med. 2021 Nov 10:lmab078. doi: 10.1093/labmed/lmab078.
Komatsu S, Yutani C, Takahashi S, Takewa M, Ohara T, Hirayama A, Kodama K, Debris collected in-situ from spontaneously ruptured atherosclerotic plaque invariably contains large cholesterol crystals and evidence of activation of innate inflammation: Insights from non-obstructive general angioscopy. Atherosclerosis 2022 Mar 10:S0021-9150(22)00130-7.
Takahashi S, Komatsu S, Takewa M, Yutani C, Kodama K. Continuous 1-Month Release of Cholesterol Crystals in a Patient with Acute Coronary Syndrome after Stenting. JACC Case Reports, 2022 May 4;4(9):549-550. doi: 10.1016/j.jaccas.2022.03.019.
Noda H, Yutani C, Zaima N, Komatsu S, Iwa N, Takahashi S, Takewa M, Ohara T, Kodama K. Detection of Macrophages Engulfing Cholesterol Crystals and Docosahexaenoic Acid from Spontaneous Ruptured Aortic Plaque J Cardiol Cases, 2022 Aug 18;26(5):364-366. doi: 10.1016/j.jccase.2022.08.001.
Higuchi Y, Hirayama A, Hamanaka Y, Kobayashi T, Sotomi Y, Komatsu S, Yutani C, Kodama K. Significant Contribution of Aortogenic Mechanism in Ischemic Stroke: Observation of Aortic Plaque Rupture by Angioscopy. JACC Asia. 2022 Nov 1;2(6):750-759. doi: 10.1016/j.jacasi.2022.07.009.
Takahashi S, Komatsu S, Yutani C, Takewa M, Ohara T, Kodama K. Serial Observation of Aortic Puff-Chandelier Rupture for 2 Years by Non-Obstructive General Angioscopy. Circ J. 2022 Feb 25;86(3):476.
Komatsu S, Yutani C, Takahashi S, Takewa M, Iwa N, Ohara T, Kodama K. Cholesterol Crystals as the Main Trigger of Interleukin-6 Production through Innate Inflammatory Response in Human Spontaneously Ruptured Aortic Plaques. Journal of Atherosclerosis and Thrombosis 2023 Apr 19. doi: 10.5551/jat.64098.
Komatsu S, Takahashi S, Takewa M, Ohara T, Yutani C, Kodama K. Demonstrating an Adult Ventricular Septal Defect using Non-obstructive General Angioscopy. Cureus, in press.
Komatsu S, Takahashi S, Yutani C, Ohara T, Takewa M, Kodama K. Angioscopy-guided Selective Pulmonary Thrombectomy and Angioscopy-monitored Systemic Thrombosis for a Pulmonary Embolism. Cureus, 2023 May 1;15(5):e38365. doi: 10.7759/cureus.38365.
Komatsu S, Takahashi S, Yutani C, Takewa M, Ohara T, Kodama K. Multiple and Multi-directional Fissure Bleedings in a Patient with a Spontaneous Isolated Dissection of the Iliac Artery. Cureus, 2023 May 1;15(5):e38374. doi: 10.7759/cureus.38374.
Takahashi S, Komatsu S, Yutani C, Takewa M, Ohara T, Kodama K. Atherosclerosis of the Aorta Before Blue Toe Syndrome: Spontaneously ruptured aortic plaques Revealed by non-obstructive general angioscopy. J Cardiol Cases, in press.doi.org/10.1016/j.jccase.2023.06.005