CARDIOVASCULAR CENTER MEDICAL PROFESSIONAL: FOR PHYSICIANS About Us IryoJyujisyaMukeEn
MEDICAL PROFESSIONAL: FOR PHYSICIANS About Us
The MMAH Cardiovascular Center is a comprehensive facility staffed to provide a 24-hour response to the emergency cardiac care needs of the community.
In order to provide advanced medical care specialized in cardiac disease, three cardiovascular doctors and one cardiovascular surgeon are on call for emergency patients during nights and holidays.
There are nineteen cardiovascular specialists and four cardiovascular surgeons, dedicated to their life’s work at the Cardiovascular Center throughout the year.
We are here for you, nonstop.
The MMHA professional team, with area of expertise listed below, practice ultimate care, listen closely to each patient and their family, and do what is the best for patients.
- Operating Department Practitioner
- Cardiac Surgeons
- Specialized Nurse/ Certified Nurse
- Radiologic Technologist,
- Clinical Laboratory Technician,
- Medical Engineer /Biomedical Equipment Technician（BMET）
- Hospital Administrator
- System Engineer
- Regional Coordinator
- Clinical Research Coordinator
- Clerks and more.
Cardiovascular Diagnostic Division
The MMAH cardiovascular treatment team maintains the highest standard; our state of the art facility is equipped with the latest technologies and high quality instruments to provide examinations and therapies of the highest standard.
- ICU and CCU (14 beds in total)
- Physiological examination room (cardiac ultrasonic device, treadmill exercise load device, Holter ECG test)
- Coronary CT device
- Cardiac MRI device
- Nuclear medicine test equipment
- Four cardiovascular examination rooms
- Hybrid operating room
- Cardiovascular surgery operating room
- Cardiac rehabilitation room
Our aim is to establish cutting-edge treatment that can be completed within our region.
We are striving day and night to achieve the highest medical standard in Japan. Thirteen Fellows of Japanese Circulation Society (FJCS), three Board Certified Members of the Japanese Association of Cardiovascular Intervention and Therapeutics (BMCVIT), six Fellows of the Japanese Association of Cardiovascular Intervention and Therapeutics, one Board Certified Member of the Japanese Heart Rhythm Society, three Board Certified Members of the Japanese Society for Vascular Surgery, and five cardiac rehabilitation instructors stand at the forefront of the MMAH Cardiovascular Center. They have devoted their life’s work to their patients. We are equipped with a wide range of certified facilities in the cardiovascular field.
To maintain highly qualified excellent medical care, the cardiovascular team visits all of our patients every Monday morning. For patient status evaluation and constructive feedback, we hold in-hospital conferences twice a day, every morning and afternoon from Monday to Friday. Cardiovascular physicians come together for building the strategy for complex and severe cases by exchanging opinions within their own specialized field.
Our weekday starts at 7:40 with conferences and self-education sessions like
- Cardiovascular Disease/Treatment Lecture
- Latest study Paper Extraction
- Echocardiography Conference
- Heart Failure Conference
- Cardiac Rehabilitation Conference
- Valvular Disease Conference (TAVI, Cardiovascular Surgical Procedure)
Following the morning session, an ICU conference with cardiologists, cardiovascular surgeons and the ICU nurse starts from 8:10.
In addition, we actively work on clinical research and participate in clinical studies, so that we can present our work and share with the communities around the globe. Please follow the link to find more about our work at MMAH:http://www.cure.or.jp/cardiovascularcenter/result_int.html
We are proud of the commitments our cardiovascular physicians make in conducting coronary angiography, PCI (percutaneous coronary intervention), catheter ablation, EVT (Endovascular Treatment), case review meetings for critical cases, and regular preoperative conferences on cardiovascular surgery.
For Our Community
Making our communities better makes us all better.
We have an enduring commitment to a healthier Miyazaki, and partner with medical organizations, local hospitals, clinics, and emergency medical services that share our vision.
As primary prevention, we hold public lectures to advocate to citizens how to prevent heart disease. The aim of secondary prevention is to deepen patients' understanding through actual cardiac rehabilitation inside the hospital.
We take strong responsibility to maintain reliability and a favorable relationship with the local ambulance team; we hold regular cardiovascular disease study sessions and have an established system in place to accept emergency cases at any time.
1 Career Opportunities at Department of Clinical Laboratory in MMAH Cardiovascular Center
Whatever happens next in your life, your HEART has to be cared for first.
At MMAH you will find some of the top cardiac physicians in Japan, leading technologies, cutting-edge medical equipment, and excellent treatment options right in our community.
Physiological examination: echocardiography rooms for in-depth analysis are directed by Shun Nishino M.D., Ph.D.
Two echocardiography specialists conduct daily examinations along with clinical engineers. With improvements to increase the examination quality, approximately 15,000 transthoracic/lower extremity arterial echocardiography examinations are conducted each year. Our annual database also indicates that approximately 500 transesophageal echocardiography examinations (e.g. pre-catheter ablation thrombus evaluation and valvular heart preoperative evaluation) are performed. Stress echocardiography is conducted about 50 times per year. Through reading conferences held every friday at 16:30, we review each case for further study and improved insight.
Throughout the year we actively contribute presentations for various research societies in Japan such as the Japanese Circulation Society, the Japan Society of Ultrasonics in Medicine, and the Japan Society for Heart Valve Disease. Our vision extends internationally and research results from the echo chamber are presented annually to the American Society of Echocardiography (ASE), the European Society of Cardiology (ESC), and the European Association of Cardiovascular Imaging (EACVI). We also make a study report every year mainly focusing on valvular disease, based on the enormous amount of echocardiography data that has been accumulated by our department. For information from the past five years, please see the references below.
Along with the daily medical care, we also hold academic workshops for hospitals in Miyazaki City, designed to meet the unique needs of our community. In addition to regular hospital hours, the clinical laboratory and examination teams are available for emergency cases after hours and on weekends.
Our team is striving for healthier hearts in Miyazaki, and we believe that perseverance is required for high-quality results. We have a professional and supportive environment that welcomes those who are interested in the field of cardiac ultrasound. If you are considering applying for our team, we would be pleased to have you come to observe.
●Miyazaki City Medical Association Hospital: Study reports on cardiac ultrasound from the past five years
- Watanabe N. The Mitral Valve Complex: Divine Perfection. Circulation Cardiovascular Imaging.2016; 9.
- Nishino S, Watanabe N, Kimura T, Enriquez-Sarano M, Nakama T, Furugen M, Koiwaya H, Ashikaga K, Kuriyama N, Shibata Y. The Course of Ischemic Mitral Regurgitation in Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention: From Emergency Room to Long-Term Follow-Up. Circulation Cardiovascular Imaging. 2016 Aug; 9(8):e004841.
- Watanabe N. Mitral Valve Leaflet Remodeling After Myocardial Infarction: Good or Evil? Circulation Cardiovascular Imaging. 2017;10.
- Watanabe N. Noninvasive assessment of coronary blood flow by transthoracic Doppler echocardiography: basic to practical use in the emergency room. J Echocardiogr. 2017; 15:49-56.
- Watanabe N, Maltais S, Nishino S, O'Donoghue TA, Hung J. Functional Mitral Regurgitation: Imaging Insights, Clinical Outcomes and Surgical Principles. Prog Cardiovasc Dis. 2017 Nov - Dec;60(3):351-360.
- Nishino S, Watanabe N, Kimura T, Kuriyama N, Shibata Y. Acute Versus Chronic Ischemic Mitral Regurgitation: An Echocardiographic Study of Anatomy and Physiology. Circulation Cardiovascular Imaging. 2018 Apr;11(4):e007028.
- Watanabe N, Nishino S, Shibata Y. Simple and easy quantitation of functional mitral valve area using novel automated flow measurement technique with real-time 3-D color Doppler echocardiography. J Echocardiogr. 2018 Dec;16(4):189-191.
- Kimura T, Roger VL, Watanabe N, Barros-Gomes S, Topilsky Y, Nishino S, Shibata Y, Enriquez-Sarano M. The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study. European Heart Journal Cardiovascular Imaging.2019 Apr 1; 20(4):396-406.
- Nishino S, Watanabe N, Ashikaga K, Morihisa K, Kuriyama N, Asada Y, Shibata Y. Reverse Remodeling of the Mitral Valve Complex after Radiofrequency Catheter Ablation for Atrial Fibrillation: A Serial Three-dimensional Echocardiographic Study. Circulation Cardiovascular Imaging. 2019 Oct; 12(10):e009317.
- Watanabe N. Acute mitral regurgitation. Heart.2019; 105:671-677.
- Furugen M, Watanabe N, Nishino S, Kimura T, Ashikaga K, Kuriyama N and Shibata Y. Unique Mechanism of Mitral Valve Prolapse in Atrial Septal Defect: Three-dimensional Insights Into Mitral Complex Geometry Using Real-Time Transesophageal Echocardiography Echocardiography (Mount Kisco, NY). 2020:10.1111/echo.14623.
2 PCI (Percutaneous Coronary Intervention)
MMAH provides advanced PCI training through a self-established program for anyone to learn PCI. Our practice is based on the guideline provided by Japan Circulation Society, under the guidance of one of most highly skilled experts in the region.
We believe in hands-on experience-based learning, and welcome anyone who is willing to learn. With the astoundingly high number of coronary angiography examination cases we conduct at MMAH, you can learn all the techniques logically and thoroughly.
To improve the accuracy for an ischemia diagnosis, an exercise stress test, stress echocardiography, and myocardial scintigraphy are often performed. From the summer of 2020, cardiac MRI and cardiac-specific myocardial scintigraphy will be introduced at the completely renewed MMAH.
Pre-operational coronary CT is available for intravascular imaging. In addition, IVUS (includes NIRS-IVUS), OCT, OFDI, and Angioscope are all available to perform during the operation. You will receive in-depth guidance on projection and evaluation from senior doctors skilled in cardiovascular imaging.
MMAH will provide the best coaching to all residents and doctors through integrated clinical practice, education, and research.
Careers we offer: as one of the nation’s most comprehensive heart disease treatment networks, we can offer to residents and doctors an astounding range of disciplines and PCI specialties. You will hone your skills for a noble purpose.
Discover yourself and find your place here at MMAH.
3 EndoVascular Treatment
At our hospital, using the techniques we inherited from PCI (Percutaneous Coronary Intervention) we carry out about 250-300 peripheral vascular intervention (EVT: Endovascular Treatment) procedures every year, covering 70% of cases within Miyazaki.
With new devices and improved outcomes, we have seen continuously increasing demand for EVT, not only for simple cases, but highly demanding complex cases as well, particularly in the lower limb arteries.
Even if you have never taken part in an EVT procedure before, you will be given lots of opportunities to learn, from the fundamentals of endovascular disease to all the treatment options, to how to conduct an EVT procedure to how to be an operator yourself, all here at MMAH with the help of specialists
At MMAH, you can learn not only PCI techniques, but also EVT techniques which will bring positive impact on your PCI skills, setting you with breadth of knowledges and skillsets.
4 TREATMENT of ARRHYTHMIAS: Heart Rhythm Abnormalities
Our Commitment to Miyazaki Citizens
At our facility we annually perform 490 ablation procedures (2019). We are currently accepting patients who are recommended for ablation treatment by their primary care doctor. At MMAH ablation operations are scheduled from Monday to Friday, except for Tuesday when we have outpatient examination scheduled.
Our cardiovascular specialists at MMAH can treat most atrial fibrillation cases by a noninvasive catheter ablation, rather than a surgical approach. There are also other treatments available for patients who have a wide range of arrhythmia types, including atrial tachycardia, ventricular arrhythmia, paroxysmal supraventricular tachycardia, and ventricular tachycardia.
Through these experiences our arrhythmia team has successfully treated many complex procedures, and have actively been involving young cardiology physicians in the ablation procedure. This training allows them to investigate arrhythmia and learn therapy procedures in depth, leading to enthusiasm and understanding for their future career prospects.
It is often said that heart institutes to use only one of two possible cardiac mapping devices: CARTO or ENSITE, for ablation procedure. At MMAH, we have both systems on site. Since two systems have both strengths and weaknesses, we make use of both systems, to perform cutting edge treatment, while also to provide learning experience of both 3D cardiac mapping devices for young physicians.
Recently, we have also started using RHYTHMIA, which is the very latest treatment system. Options for arrhythmia treatment will continue to expand in the future, making it possible to provide even higher quality medical care.
We have a strong focus on pioneering medical devices for the heart’s electrical system for our patients. New physicians can anticipate training in implantation of pacemakers, ICD, and CRTD, under the guidance of board certified members of the Japanese Heart Rhythm Society, and Fellows of Japanese Circulation Society (FJCS).
We have highly motivated and active team, and are always open to young physicians seeking advice. Join us at MMAH, and let’s raise the bar of ablation therapy in Miyazaki.
5 STRUCTURAL HEART DISEASE
For the next level of intravascular interventions for coronary arteries or peripheral vessels at MMAH, noninvasive catheter treatment for structural heart disease is centered in the hybrid operation room in recent years. We mainly treat Valvular disease, a structural heart disease (SHD) intervention that is spreading rapidly in Japan. In this era of new technology, a cardiac operation called TAVI is becoming our major mission for us to improve the QOL of elderly cardiac patients with severe valve condition.
Our SHD intervention therapy includes TAVI (Transcatheter Aortic Valve Implantation) approved in October 2013, “MitraClip” for TMVR (Transcatheter Mitral Valve Repair) approved in April 2018, and “WATCHMAN” (left atrial appendage closure system) to prevent cardiogenic embolism, approved in September 2019.
In October 2015, we installed a hybrid operation room (HOR) in cooperation with PHILIPS Co. Since then, MMAH has introduced TAVI from April 2016, MitraClip from December 2018, and WATCHMAN from December 2019. As of May 2020, we have demonstrated excellent outcome, with zero peri-operative mortality.
At our brand new hospital relocation in August 2020, a hybrid operating room equipped with the latest X-ray angiography system (Azurion7 C20 with FlexArm, Philips) is set in operation, and an echo image is obtained on the X-ray fluoroscopic image. This latest system provides the cutting-edge technologies like “real-time fusion imaging”, enabling us to give the patients the latest treatment options.
In SHD intervention, the existence of a Heart Team including imaging specialists, cardiovascular surgeons, anesthesiologists, and medical staff is extremely important. Cross-functional discussion within the heart team is necessary for preoperative evaluation and case selection. Daily joint conferences with cardiologists and cardiovascular surgeons with different expertise are also critical. This joint conferences provides the team with platform to openly discuss each patient care strategy, and decide on the best therapy options available. To seek the best outcome for our patients, we continue to hold conferences, such as weekly echocardiographic case reviews and preoperative case conferences within the Heart Team, to learn and educate ourselves.
Our dedication to enhancing the treatment of structural heart disease is our commitment to the citizens of Miyazaki.
6 Our Determinations in Heart Failure Community
According to a 2018 survey report by the Statistics Bureau of the Ministry of Internal Affairs and Communications, Japan has the highest percentage of the total population of the elderly in the world (28.1%). In fact, the number of patients with heart failure due to the aging factor is ever increasing. Correspondingly, this fact can suggest a “pandemic of heart failure—leading to a global pandemic" in the near future.
This potential pandemic calls for not only treatment of heart failure in general, but also comprehensive intervention by multi-disciplinary teams at each medical institution. Heart failure prevention, recurrence prevention, and rehabilitation are three important elements for the treatment of heart failure patients.
In Miyazaki, we strive to establish a comprehensive collaboration care system for heart failure patients including three institutions: first acute care medical institutions like MMAH, secondly recovery-stage care medical institutions that perform rehabilitation during convalescence, and lastly the importance of home-doctors who can visit anytime should be more widely acknowledged.
Our mission is to build a collaborative system for heart failure medical treatment that matches the regional characteristics of Miyazaki.
In particular, heart failure in the elderly has many peculiar problems not limited only to the heart, but also of frailness (physical or mental infirmity due to aging), sarcopenia (natural loss of muscle tissue in the aging process), dementia, as well as economic and social background.
It is necessary to build a community team that comprehensively cares for elderly heart failure patients in a regional manner by strengthening cooperation not only with medical institutions but also with geriatric health facilities and home nursing care. We have created and are following the heart failure handbook for Miyazaki, stating our own clinical path for regional cooperation for heart failure, and utilize it for the development of advanced medical care for heart failure.
Aiming at heart failure treatment and regional medical cooperation that is appropriate for Miyazaki Prefecture, we hold seminars and research meetings about twice a month with multiple experts from both inside and outside the hospital.
Catheter therapy for coronary artery disease and valvular disease is in the limelight treating for heart disease. However, the diagnosis of heart failure is of paramount importance because cardiovascular disease can result in heart failure. Heart failure collaboration is the field of the future, and we hope you join us at MMAH, where you will be exposed to very unique and rewarding experiences through multi-professional cooperation and regional coordination.
7 Rehabilitation Division
Our staff in Rehabilitation division
Of ten Physical Therapists, six Physiotherapists are in charge of cardiac rehabilitation: four specializing in cardiac patient rehabilitation, two specializing both in cardiac disease and orthopedics.
Certifications / Qualifications
Five Japanese Association of Cardiac Rehabilitation-certified Therapists
Five certified members of the Japanese Physical Therapy Association: two for cardiovascular disease, one for pulmonary disease, three for orthopedic disorders
Three certified respiration therapists
Target cardiac disease and its numbers, 2019
In 2019, 761 cardiac patients underwent rehabilitation for recovery. The graph shows the breakdown of 590 cases from cardiology and 171 cases from cardiovascular surgery. Most cases were indicated with heart failure or acute myocardial infarction.
The need for cardiac rehabilitation has been increasing yearly. We have constantly been conducting more than 700 cases annually in recent years.
Our medical rehabilitation plans are based on a cardiac physician’s prescription, especially for patients with heart failure or myocardial infarction. In the acute phase the physical therapist in charge will provide one-on-one instruction at the bedside. While confirming the condition with the cardiac physician, exercise will be increased, and finally proceed to the next stage such as group rehabilitation or CPX. If problems arise, consultations are held in the cardiac rehabilitation conference to enable patients to return home as soon as possible.
Cardiopulmonary exercise testing; CPX
This is a test that simultaneously measures cardiopulmonary function, skeletal muscle function, etc. during exercise. A gas analyzer measures how much oxygen is being inhaled and how much carbon dioxide is being exhaled in one minute, and the anaerobic threshold (AT), which is an index of cardiopulmonary function, is calculated. This enables heart disease patients to enjoy efficient exercise in a safe range of intensity. Additionally, it can be a tool for determining the possibility of heart disease, such as coronary artery disease, and a measurement for the severity of the disease using an electrocardiogram. Since it is possible to evaluate the degree of heart failure by measuring the cardiac reserve, it is also used as a stress test for cardiac rehabilitation.
At MMAH, the cardiac physician attends the CPX and conducts examinations with the physiotherapist in charge, to make it possible to have a more effective CPX
Cardiac Rehabilitation Conference
A weekly meeting is held on Tuesday mornings to check the current status of rehabilitation and discuss issues regarding ongoing cases. Professionals from various fields, including physiotherapists, cardiologists, nurses, medical technical staff, social workers, and medical clerical workers participate and comprehensive care and medical strategies from various perspectives are planned for each case. The physical therapists share information on daily rehabilitation and CPX, and concentrate on the physical (and often psychiatric) problems of each case. Nurses and social workers will focus on the patients’ social background. This leads to the construction of a concrete treatment plan.
For your career
Cardiac rehabilitation, along with pharmaceutical therapy, cardiac catheterization, and cardiovascular surgery, are very important aspects of treatment for patients with cardiac disease. It is important to provide comprehensive care for patients with heart disease, because it is often necessary to take a social approach as well as treating the physical and psychiatric concerns. At MMAH an environment is in place where professionals with different expertise can share information and exchange their opinions. The staff of the rehabilitation division are strongly committed to helping shape advanced cardiac rehabilitation therapy for Miyazaki citizens. We welcome you to join us in this task!
8 Our cardiovascular intensive care unit
At MMAH, we have 12 CCU (Cardiovascular Intensive Care Unit) beds. In 2019, the CCU team took care of 178 out of the 233 emergent patients with acute coronary syndrome. The number of emergent cardiac patients who are transferred to, and accepted at our hospital is one of the highest in Japan. The Open CCU allows each attending physician and cardiac specialist to be involved in the treatment, and to become well versed in acute hemodynamic management and cardiovascular/respiratory assistance devices. In addition, we have a unified team treatment system based on the daily rounds and conferences.
A round of visits to a cardiovascular intensive care unit (CCU): Updated photo will be retaken
Insert a breakdown case graph. (Statistics are currently surveyed.)
Medical facilities and devices
For the best treatment for saving life, we utilize variety of assist devices such as ventilator, artificial dialysis, intra-aortic balloon pumping (IABP), percutaneous left ventricular assist device (Impella®︎), VA-ECMO, etc.
As One Team
The cardiovascular intensive care unit is designated to provide the highest level of care to patients in critical stage. We save lives making full use of various devices. Our mission is to humbly and openly discuss and implement the best available treatment for each one of our cardiac patients. Not only do we case with many patients every day, we also have top-notch physicians in the nation on team to lead us.