To Patients and Their Families

Adult Congenital Heart Disease (ACHD) is a condition in which people born with heart defects must continue to manage their heart health well into adulthood. There are approximately 600,000 patients in Japan, and it is said that this number is increasing by about 10,000 each year. For about 20 years now, Japanese newspapers and other media have been reporting on the shortage of medical facilities capable of treating these patients. While the situation may still not be ideal, many medical institutions have been making efforts to address this issue. Just as patients with common conditions such as cancer or cardiovascular disease choose medical institutions for second opinions, it is only natural for ACHD patients to select facilities that can provide specialized testing and treatment.


The doctors at the hospital where you were treated as a child cannot continue to care for you indefinitely. As you become an adult, your body grows, and other health issues may arise. Therefore, it becomes necessary to gradually transition care to internal medicine and surgical departments that specialize in treating adults. This process is called “transitional care.” The time when you leave your parents’ home to start a career or get married is a very important period. Let’s ensure you can move forward to the next step with peace of mind, fully understanding “what you need to watch out for from now on” and “whether you’ll need another surgery.”


In this consultation service, we’ll work together to address questions like these:


Is my current treatment plan sufficient?
Do I need more detailed tests?
Will I need treatment again in the future?
Where can I receive a specialized medical examination?


People with congenital heart disease often feel anxious about school life, further education, and employment starting as early as middle or high school. Therefore, it is important to learn about your condition while you are still young—in your teens or early twenties (the AYA generation). Understanding your condition and gradually thinking through what you can do on your own will give you the strength to face your condition with a positive attitude.


Patients with adult congenital heart disease (ACHD) have complex heart structures, and many have undergone multiple surgeries during childhood. Even if they were healthy as children, problems with heart function, valves, or blood vessels may arise decades later.


The history of cardiac surgery is still relatively recent, and there is much we do not yet understand. Consequently, each person’s specific concerns are different. That is precisely why personalized counseling is so important.


Dr. Itatani is a cardiac surgeon who has been at the forefront of surgical treatment for adult congenital heart disease (ACHD) in Japan. He has established treatment centers for adult congenital heart disease in several major cities, where he has addressed both surgical issues and problems related to blood flow (hemodynamics).


He is currently practicing at the Department of Cardiovascular Surgery at Juntendo University so that he can treat a larger number of patients.


At this consultation service, you can discuss the following topics from a professional perspective:


What kind of condition you have, and when and what kinds of tests you should consider
If additional treatment is likely to be needed in the future, when and what kinds of treatments might be considered
How treatment is likely to affect your work and daily life

Reoperation for Congenital Heart Disease in Adults

In cases of congenital heart disease in adults, heart valves or blood vessels repaired during childhood may require further treatment, and as patients grow, they may develop arrhythmias or heart failure that necessitate treatment. In some cases, this may involve a second or subsequent open-heart surgery, which increases both the technical difficulty and the risks involved.
These surgical interventions are not limited to patients in life-threatening emergencies; it is not uncommon for them to be necessary for patients who experience fatigue or palpitations during daily life or at work. It is important to undergo surgery at the appropriate time to ensure the heart can withstand the strain of work, exercise, and—for women—pregnancy and childbirth.
However, because cardiac surgery for congenital heart disease in adults is extremely complex, the reality is that even among developed countries, including Japan, there are very few hospitals that perform such surgical treatments. Dr. Itatani is a cardiac surgeon specializing in these conditions. With extensive surgical experience, he has treated a wide range of pathologies involving complex anatomy. In the past, he has performed the following advanced surgical procedures. Through this online consultation service, he is available to advise those who are unsure whether to seek a second opinion or who are considering when and where to undergo surgery. Below is a list of the surgical procedures Dr. Itaya has specialized in performing.

• Pulmonary valve replacement with biological or prosthetic valves, or concurrent surgery for other heart valves or arrhythmias, in patients who have undergone repair using valve-tipped patches for conditions such as Tetralogy of Fallot
• Revision surgery following repair using a valve-tipped artificial vessel for the right ventricular outflow tract (Rastelli procedure) in cases of Tetralogy of Fallot and similar conditions
• Surgery for aortic valve or aortic root aneurysms following congenital heart disease surgery (valve-sparing or prosthetic valve replacement)
• Valve repair or replacement surgery for congenital atrioventricular valves
• Revision surgery for circulatory failure or arrhythmias following single-ventricle repair (post-Fontan surgery)
• Surgery for biventricular pacing due to right ventricular failure or for atrioventricular regurgitation
• Valve repair or replacement surgery for tricuspid valve diseases, such as Epstein’s anomaly
• Medical management and combined surgical treatment for congenital heart defects involving holes in the heart (such as atrial septal defect, ventricular septal defect, atrioventricular septal defect, and anomalous pulmonary venous return) complicated by pulmonary hypertension or valvular heart disease
• Aortic arch surgery and revision surgery for patent ductus arteriosus and aortic coarctation
• Coronary artery repair and coronary artery bypass surgery for congenital coronary artery disease

On Cutting-Edge Research in Blood Flow Analysis

In many cases, performing such complex surgeries is difficult to master through surgical experience alone. This is because the field of congenital heart disease in adults still lacks sufficient experience and data, and there are many aspects that remain unknown.
Dr. Itatani has been conducting research on “blood flow analysis,” a technique that visualizes blood flow within the heart and blood vessels using images and simulates it on a computer. By combining this method with clinical practice, we can examine the specific issues affecting each patient’s heart in greater detail and carefully plan surgical procedures.
Blood flow analysis helps us understand the movement and blood flow within the complex structure of the heart. Even when surgery is not necessary, a detailed examination of the condition of the heart and blood vessels using 4D imaging tests (such as 4D Flow MRI) can confirm the current state of the heart and provide guidance for continuing daily life with peace of mind.
At this consultation office, we also welcome inquiries such as, “Should I undergo such a test?” For those who wish, we are considering providing the analysis results separately.