第１３回日本成人先天性心疾患学会
On behalf of the Japanese Society of Adult Congenital Heart Disease (JSACHD), it is my great honor and pleasure to welcome all of you to the 13th Annual Meeting in Fukuoka, Japan, January 8 to 9, 2011.
JSACHD was established in 1999. Our mission is to pursue and promote better care for adults with congenital heart disease and to facilitate collaboration and cooperation among pediatric cardiologists, adult cardiologists, cardiovascular surgeons, obstetricians, psychologists and other allied healthcare givers. All these healthcare providers have participated in the annual meetings along with guests from foreign countries. We have had many earnest discussions concerning adult patients with congenital heart disease. The 13th annual meeting of JSACHD is going to be held in Fukuoka, which is the nearest Japanese city to other Asian countries.
During the last 30 years the evolution of patient management and surgical techniques has contributed to an increase in survival rates for many patients with congenital heart disease. In Japan, the number of adult patients with congenital heart disease is estimated to be about 500.000. Presently, this number has exceeded that of children with CHD. Some of the adult patients suffer not only from physical problems but also from social, economic and psychological obstacles. However, our understanding of these difficulties is not deep enough to allow us to reach our goal of a comprehensive management system for adults with CHD yet.
In this year's Meeting of JSACHD we are going to have discussions focusing on two specific issues. One topic will be the long-term mobility and mortality of adult patients who have had a Fontan operation. Although management techniques have evolved favorably over the last decades and we have seen increased achievement rates for Fontan patients, ultimately we do not know if we are providing a favorable quality of life for them. Thanks to the JSACH core members, our Questionnaire Survey revealed that about 900 adults living in Japan underwent a Fontan operation and provided some initial insight into their quality of lives. Especially now, when we are beginning to recognize many cardio-pulmonary problems as well as difficulties with other organs such as the liver and the kidneys. How do we meet these challenges? What will we need to provide for them? We would like to hear about and discuss long-term management of adult Fontan patients with our colleagues from other countries.
The second topic focuses on advancements in cardiac imaging modalities. When and what should we select for our patients among the many modern techniques which have developed so quickly in the last several years. In practice, intra-hospital networks are a fundamental necessity for medical teams dealing with adult CHD patients. For this meeting, several distinguished speakers will offer us their insights. Dr. Driscoll from the Mayo Clinic, Dr. Oecslin from Toronto General Hospital, Dr. Kaemmerer from the Munich Heart Center, Dr. Choi from Yonsei-Seoul, Dr Kondou from TWMS-Tokyo and Dr. Noma from KKNH-Kitakyushu will all present their views. The knowledge we will gain from their insights should encourage us to forge ahead into these complicated emerging fields.
Ninety papers based on our members’ clinical experience and studies concerning with variable topics of ACHD will be presented and discussed. Your participation in the meeting and your contribution to the discussions will be very much appreciated. I am sure that it will make the meeting meaningful and valuable for all of the participants as well as the adult patients you represent.
You and your families are sure to have a wonderful time in Fukuoka on the southernmost Japanese island of Kyushu. You will be able to enjoy sightseeing, going to hot springs and having Japanese food, such as sushi and Hakata Ramen along with sake.
Finally, I hope that your happy and prosperous year 2011 starts at the meeting.
January, 2011
Kunitaka Joo, M.D.
President of 13th annual meeting of JSACHD.
Vice President, Kyushu Koseinenkin Hospital,
Kitakyushu, 805-8501 Japan
e-mail address: k-joo@qkn-hosp.jp
“Loeb’s Four Rules of Medicine
1. If the patient is getting better, keep doing what you are doing
2. If the patient is getting worse, change something
3. If you are not sure what you are doing, doing nothing
4. Try to keep the patient out of the operating room”
(from Driscoll’s Fundamentals of PC, 2006: 89)
第13回日本成人先天性心疾患学会の開催にあたり
Who studies medicine without books sails an uncharted sea, but who studies medicine without patients does not go to sea at all.” (William Osler, 1847-1919)
「第13回日本成人先天性心疾患学会」，2011年1月8日‐9日「福岡国際会議場」（福岡市），の開催にあたり，ご挨拶申し上げます．
本学会は，1999年1月に「日本成人先天性心疾患研究会」として発足し，小児循環器科医，循環器内科医，心臓血管外科医および産婦人科医の各専門分野の垣根をこえた学際的交流にとどまらず，看護師はじめ多種類の診療協力部門の参加をえて，全国の診療ネットワーク構築のための日常活動をめざしています．2010年1月に研究会から学会へ発展した機会に，九州ではじめて催されることの意義は大きいと考えます．
先天性心疾患の診療は，小児科のかぎられた専門分野とされていたのに，なぜ，成人先天性心疾患なのでしょうか．過去30年間の先天性心疾患をめぐる医療，とくに心臓血管外科治療が著しく進歩し，新生児乳児期に多くが失われてきた患者さんは，今や，その約90％が長期生存できる時代になりました．しかし，このことは新たな課題を私どもに突きつけています．1997年，本邦の先天性心疾患の患者さんは622,800名で，成人はその時すでに318,326名（51%）でした．その後も，毎年約9,000名が成人に達するため，2007年には409,101名の成人先天性心疾患の患者さんが生活していると推測されています（椎名）．そのなかには，かなりの頻度で，重大な医学的社会的問題をかかえて専門的診療や援助を必要とする患者さんが居られることも明らかとなりつつあります．
欧米諸国では，早くから成人先天性心疾患専門医を軸にした診療体系が構築され，科学的根拠に基づいたガイドラインが提案されています．しかし，我が国では，残念ながら，孤立した経験による対応にとどまっています．国際交流に学ぶところの多い分野であり，今回も海外から講師４名を招聘します．アジアへの窓口福岡市での開催には，発展著しい韓国や台湾からの一般参加も期待されます．
第13回学会の企画にあたり，私自身が日々の診療で直面する課題二つを取りあげて講演やシンポジウムとしました．まず，「フォンタン手術後遠隔期」；過去30年間の臨床を振りかえれば，多くの重症心疾患を新生児期に失った10年，フォンタン手術への到達と手術法改良への期待の10年，そして，やはり不整脈や肝機能障害，蛋白漏出性腸症(PLE)に不安を強くする10年に区分され，今，Driscoll先生の長い臨床経験に学びたいという思いを強くしています．ドイツやカナダ，お隣韓国の事情はどうでしょうか．Kaemmerer先生，Oechslin先生，Choi先生に，それぞれ，応えていただきましょう．この企画に際し全国の会員にアンケート調査を実施したところ，本邦ではフォンタン術後成人に達して外来診療中の方は，すでに900名を超えていることが判明しました．多忙な診療の中，ご協力いただいた皆さまに深く感謝するとともに，課題の大きさと深さに足がすくむ思いです．
つぎに「発展著しい画像診断の臨床応用」；経胸壁心エコー検査や心血管造影に満足できない分野です．経食道心エコー検査，MD-CT, MRI, シンチグラフィーなどの選択と組合せが提案されるでしょう．野間充先生と近藤千里先生には，「情報ネットワークシステム」と「被爆線量への配慮」に係る教育講演を‐ランチョン・モーニングで‐お願いしました．ご期待ください．
不慣れな準備と広報にもかかわらず，過去最多の90演題の応募をいただいた皆さまに感謝します．ご多忙な折，何かとご助言いただいた理事長，座長を快諾された理事等関係の皆さまに感謝します．学会の趣旨にご賛同される皆さまには，各施設の同僚，小児循環器医・循環器内科医・心臓血管外科医・看護師・臨床心理士などをお誘いのうえ，学会を盛り上げていただくよう重ねてお願い申し上げます．プログラムや運営上の不備はご海容くださり，限られた時間ですが，創意工夫ある研究成果の発表をかこむ活発な議論を期待します．
末筆ながら，新年早々の本学会が，皆さまのご多幸と発展の門出となることをこころより祈念いたします．
2011年1月
第13回日本成人先天性心疾患学会
会長 城尾 邦隆
（九州厚生年金病院 副院長）