Cardiac Surgery - Shinzougeka

A field of surgery that treats congenital and acquired heart disease and abnormalities of the major blood vessels around the heart through surgical procedures. Since ancient times, it was believed that cutting into the heart would lead to death, and surgeons did not even reach the heart. However, from the 19th to the 20th century, sporadic attempts were made in Europe to treat cardiac trauma, and there were some accidental successes, such as the successful suturing of a right ventricular incision in 1896 by Ludwig Mettler Rehn (1849-1930) of Germany. After that, there were advances in endotracheal anesthesia, blood transfusions, and antibiotics, and after the French surgeon Carrel invented the vascular suturing technique (1902), vascular surgery became popular, and it was against this backdrop that modern cardiac surgery developed mainly in the United States. That is to say, cardiac surgery as a modern treatment method is said to have begun in 1938 when Robert Edward Gross (1905-88) of the United States successfully performed a ligation operation on a patent ductus arteriosus (ductus arteriosus). After that, many cardiac surgeries were attempted in Europe and the United States, but it was not until around 1945 that it finally entered the stage of clinical implementation. However, the first open-heart surgery, in which the heart is opened to directly examine and treat the lesion, was performed in 1953 with the closure of an atrial septal defect using a heart-lung machine, making it possible to treat more complicated heart diseases. At the same time, in vascular surgery, the successful vascular replacement operation to restore blood flow after vascular resection made it possible to perform aortic resection surgery. Due to the historical relationship of these developments, cardiac surgery and vascular surgery are collectively referred to as cardiovascular surgery. Since then, cardiac surgery has made remarkable progress and has reached the stage of clinically performing heart transplants.

In Japan, research was suspended during the Second World War, but in May 1951, Sakakibara Shigeru successfully performed ligation of a patent ductus arteriosus, and in November of the same year, Kimoto Seiji (1907-95) also successfully performed palliative surgery for tetralogy of Fallot (a heart anomaly involving four conditions: ventricular septal defect, pulmonary artery stenosis, right transposition of the aorta, and right ventricular hypertrophy). Open-heart surgery was successfully performed simultaneously at Tokyo Women's Medical University and Osaka University in 1955, marking the start of full-scale cardiac surgery. After that, cardiovascular surgery developed thanks to the efforts of many surgeons. Heart transplants were difficult to perform due to issues such as brain death, but in 1997, the Organ Transplant Law was enacted, which made it possible to transplant organs from brain-dead patients, and heart transplants were resumed in Japan, with 65 heart transplants having been performed by the end of March 2009.

Factors contributing to the development of cardiac surgery include the advancement of diagnostic techniques such as ultrasound, CT scans, cardiac catheterization, and angiography, which allow for accurate detection of lesions in detail, improvements in open-heart surgery methods such as cardiopulmonary bypass, extracorporeal circulation, hypothermia, and myocardial protection, advances in pre- and post-operative management such as intensive care units, as well as advances in materials such as plastics used in artificial blood vessels and valves, and the scope of applications has expanded significantly. In particular, radical surgery for complex congenital heart disease such as transposition of the great arteries and tricuspid atresia in newborns and young children has become possible, and the safety of surgery has improved.

[Imai Yasuharu]

"Expert Cardiac Surgery Nurse, by Tatsuno Katsuhiko, revised second edition (1996, Nanzando)" ▽ "The Heart - Surgery and Internal Medicine, edited by Shirotani Hitoshi (1998, Medica Publishing)" ▽ "A Book to Understand Heart Surgery, by Koyanagi Jin (2000, Shogakukan)" ▽ "Cardiac Surgery, edited by Arai Tatsuta (2005, Igaku Shoin)" ▽ "Cardiac Surgeon, by Bando Osamu (Iwanami Shinsho)"

Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend

先天性および後天性の心臓病と、心臓周辺の大血管の異常を外科的手術によって治療する外科の一分野をいう。昔から心臓にメスを加えることは死につながると考えられて、外科医の手も心臓には及ばなかったが、19世紀から20世紀にかけてヨーロッパでは散発的ではあったが心臓外傷の治療が試みられるようになり、1896年ドイツのレーンLudwig Mettler Rehn（1849―1930）が右心室切創の縫合に成功するなど、偶発的ともいえる成功例がいくつかあった。その後に気管内麻酔、輸血および抗生物質の進歩があり、フランスの外科医カレルが血管縫合法を考案（1902）してから血管外科が盛んに行われ、これらを背景として現代の心臓外科がおもにアメリカで発展してきた。すなわち、近代的治療法としての心臓外科は、1938年アメリカのグロスRobert Edward Gross（1905―88）が動脈管（ボタロー管）開存の結紮(けっさつ)手術に成功したことから始まったといわれ、その後多くの心臓外科手術が欧米で試みられたが、1945年前後からようやく臨床実施の段階に入った。しかし心臓を開いて直接病変を見て治す開心術は、1953年に人工心肺装置を用いた心房中隔欠損症の閉鎖術が最初であり、より複雑な心臓病の治療が可能になった。同時に血管外科でも、血管切除後に血流を修復する血管置換手術が成功して、大動脈の切除手術が可能となってきた。こうした発展の歴史的関係もあって、心臓外科と血管外科は総括して心臓血管外科ともよばれる。以後、目覚ましい発展を遂げた心臓外科は臨床的に心臓移植を行う段階に至った。

　日本では、第二次世界大戦で研究が中断されていたが、1951年（昭和26）5月に榊原仟(さかきばらしげる)が動脈管開存の結紮手術に成功、同年11月には木本誠二（1907―95）もファロー四徴症（心室中隔欠損、肺動脈狭窄(きょうさく)、大動脈右方転位、右心室肥大の4病変を伴った心臓奇形）の姑息(こそく)手術に成功した。開心術は1955年に東京女子医大と大阪大学が同時に成功して本格的な心臓外科のスタートをきった。その後は数多くの外科医の努力で心臓血管外科が発展した。心臓移植の手術については脳死問題などで実施が困難であったが、1997年（平成9）に脳死者からの臓器移植を可能とする「臓器移植法」が制定されたことにより、日本でも心臓移植が再開され、2009年3月末までに65例の心臓移植が施行された。

　心臓外科発展の要因としては、超音波検査法やCT検査、心臓カテーテル法や心血管造影法などの診断技術の進歩により病変を細部にわたって的確に把握できるようになったこと、人工心肺、体外循環、低体温法、心筋保護法など開心術の手段が向上してきたこと、術中の循環動態のモニター機器をはじめ、集中治療室など術前術後の管理が進歩したこと、人工血管や人工弁などに使われるプラスチックなど材料の開発が進んだことなどがあげられ、その適応も著しく拡大されてきた。とくに新生児や幼児を対象とする大血管転移症や三尖弁(さんせんべん)閉鎖症など複雑な先天性心臓病の根治手術も可能となり、手術の安全性がより向上してきた。

［今井康晴］

『龍野勝彦著『心臓外科エキスパートナーシング』改訂第2版（1996・南江堂）』▽『城谷均編『心臓――外科・内科』（1998・メディカ出版）』▽『小柳仁著『心臓の手術がよくわかる本』（2000・小学館）』▽『新井達太編『心臓外科』（2005・医学書院）』▽『坂東興著『心臓外科医』（岩波新書）』

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