Plenary Session 6
3月27日［土］08:00-09:30
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Frontiers in Diagnosis and Treatment of Specific Aortic Diseases
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大動脈には頻度の高い解離や動脈瘤の他にも様々な疾患が発生する。血管炎として循環器領域で遭遇し問題となるのは高安動脈炎、巨細胞性動脈炎、ベーチェット病などである。最近本邦から発信されたIgG4関連疾患も血管炎を発症し、着目されている。これらの疾患は循環器内科や心臓血管外科で診療する機会が少なくない。いずれも診断面では特異的なバイオマーカーが存在していないことから、臨床所見と非特異的な炎症マーカーと画像診断に頼らざるを得ないのが現状である。画像診断は大きく進歩しており、大型血管炎ではFDG-PETの有用性が認識され普及しているが、課題も多い。治療面では従来の免疫抑制剤に加えて、トシリズマブはじめ様々な免疫抑制剤の有効性が示されている。血管狭窄・拡大や大動脈閉鎖不全の治療においては血管内治療の可否、手術の時期なども未解決の課題である。また遺伝性大動脈疾患であるMarfan症候群は近年遺伝子解析が進み、様々な類縁疾患が報告されている。このように病態解明、診断、治療面で様々な課題があり、今後の研究が待たれる疾患群である。本セッションでは広く関連の基礎研究、診断・治療面での最新情報と研究成果を持ち寄り総合的な討議を行いたい。
Dissection and aneurysm formation comprise the bulk of aortic diseases physicians see in clinical practice. However, we all know that there are many other disorders of the aorta. Large vessel arteritis affects the aorta and is divided into the following categories, Takayasu arteritis and giant cell arteritis. Behcet’s disease and IgG4-related disease also involve the aorta. The latter has been studied in great detail in Japan and has gained worldwide attention in recent years. Although they are not common, cardiologists and cardiovascular surgeons nevertheless encounter these diseases in daily practice. One of the problems with diagnosis of these less common aortic diseases is a lack of specific biomarkers for them, forcing us to rely on nonspecific inflammatory markers and various imaging tests. Advanced imaging technology such as the recently developed FDG-PET appears to be useful for detecting inflammation of large vessels, and is gaining in popularity, but there is still much to be learned. With respect to treatment of these diseases, in addition to conventional immunosuppressants, there are new ones such as tocilizumab for large vessel arteritis which are showing promise. For vascular stenosis, dilation, and aortic regurgitation, treatment including optimal timing and indications for surgery or intravascular treatment are largely unknown. Marfan syndrome is a hereditary aortic disease, for which much new information is coming to light, including the existence of closely related diseases. In this way, aortic diseases are extremely fertile ground for research: research into mechanism, research into better diagnosis, research into optimal treatment. So we are really looking forward to the sessions ahead in which we will be sharing the latest knowledge, both in clinical and basic science, in the area of specific aortic diseases.
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Mitsuaki Isobe
Sakakibara Heart Institute, Tokyo
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Eric Isselbacher
Cardiology Division, Massachusetts General Hospital, Boston, USA
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Eric Isselbacher
Cardiology Division, Massachusetts General Hospital, Boston, USA
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Takeshi Yagyu
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Medicine, Suita
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Yasuhiro Maejima
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo
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Yoshikazu Nakaoka
Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita
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Hiroko Morisaki
Department of Medical Genetics, Sakakibara Heart Institute, Tokyo
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