Thung-Lip Lee

The effect of surgical weight reduction on left ventricular structure and function in severe obesity.

The aim of this study was to examine the effect of surgical weight reduction on cardiac structure and function and to seek the determinants of these changes. Sixty‐six severely obese adults (BMI ≥35 kg/m2) who received bariatric surgery underwent echocardiographic examination before and 3 months after surgery. At 3 months after surgery, BMI and systolic blood pressure (BP) decreased (43.3 ± 6.3 to 34.1 ± 5.6 kg/m2, P < 0.001, and 146 ± 12 to 130 ± 14 mm Hg, P < 0.001, respectively). In left ventricular (LV) geometry, the relative wall thickness (RWT) and LV mass index decreased significantly (0.43 ± 0.05 to 0.35 ± 0.05, P < 0.001, and 50 ± 11 to 39 ± 11 g/m2.7, P < 0.001, respectively) without changes in chamber size. Multivariate analyses showed change in systolic BP to be an independent predictor for the changes in RWT and LV mass index. In myocardial performance, peak systolic mitral annular velocity and all diastolic indexes showed significant improvements. We concluded that LV hypertrophy and function improved rapidly after bariatric surgery in severely obese adults. BP reduction was the major determinant for the regression of LV hypertrophy in the early stage of surgical weight reduction.

Myocardial ischemia during endoscopic retrograde cholangiopancreatography: an overlooked issue with significant clinical impact

Background and Aim:  The occurrence of peri‐procedural myocardial ischemia with endoscopic retrograde cholangiopancreatography (ERCP) has been documented, but its significance remains controversial. This study aimed to investigate the incidence and risk factors of myocardial ischemia during ERCP procedures and to analyze the potential association between myocardial ischemia and post‐ERCP complications.

Glossogyne tenuifolia Extract Inhibits TNF-α-Induced Expression of Adhesion Molecules in Human Umbilical Vein Endothelial Cells via Blocking the NF-kB Signaling Pathway

Chronic inflammation plays a pivotal role in the development of atherosclerosis, where the pro-inflammatory cytokine-induced expression of endothelial adhesion molecules and the recruitment of monocytes are the crucial events leading to its pathogenesis. Glossogyne tenuifolia ethanol extract (GTE) is shown to have potent anti-inflammatory and antioxidant activities. We evaluated the effects of GTE and its major components, luteolin (lut), luteolin-7-glucoside (lut-7-g), and oleanolic acid (OA) on TNF-α-induced expression of adhesion molecules in human umbilical vein endothelial cells (HUVECs). The results demonstrated that GTE, lut, and lut-7-g attenuated the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in TNF-α-activated HUVECs, and inhibited the adhesion of monocytes to TNF-α-activated HUVECs. The TNF-α-induced mRNA expression of ICAM-1 and VCAM-1 was also suppressed, revealing their inhibitory effects at the transcriptional level. Furthermore, GTE, lut, and lut-7-g blocked the TNF-α-induced degradation of nuclear factor-κB inhibitor (IκB), an indicator of the activation of nuclear factor-κB (NF-κB). In summary, GTE and its bioactive components were effective in preventing the adhesion of monocytes to cytokine-activated endothelium by the inhibition of expression of adhesion molecules, which in turn is mediated through blocking the activation and nuclear translocation of NF-κB. The current results reveal the therapeutic potential of GTE in atherosclerosis.

Detachment of composite graft after Bentall's operation manifested as acute myocardial infarction.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 37-year-old woman with Marfans syndrome underwent a modified Bentalls operation with the coronary button technique in 2007. Eight months later, she presented with non–ST-segment elevation myocardial infarction with the

Suture knot embolism—a rare complication of percutaneous arterial closure device

Percutaneous closure devices used after percutaneous endovascular procedures have become more popular over the past decade. Occlusive vascular complication of the device is rare but always leads to limb-threatening consequence. We report a case of arterial occlusion caused by distal embolization of the suture material in the percutaneous closure device.

Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report

BackgroundBlunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy.Case presentationHere we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting.ConclusionPerfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

T-005 ELEVATED BLOOD PRESSURE IS THE MAJOR DETERMINANT FOR INCREASED ARTERIAL STIFFNESS IN OBESE ADULTS

Background Arterial stiffening can reflect early vascular damage and is associated with both target organ damage and increased cardiovascular morbidity and mortality. Studies have shown that obese adults have stiffer arteries than those of normal weight. We conducted a study to evaluate the determinants for arterial stiffness in obese adults. Methods Sixty-nine obese adults (≥20 years of age) with body mass index (BMI) ≥ 30 kg/m2 were studied. Pulse wave velocity (PWV) and blood pressure were measured by volume-plethysmographic apparatus (VP 2000; Colin Co. Ltd., Komaki, Japan). The patients’ anthropometric information, including their age, sex, height, weight and waist circumference, was recorded. Blood samples were taken for biochemical analysis of fasting glucose, total cholesterol and triglycerides. Results The average brachial-ankle PWV correlated with systolic blood pressure (P < 0.001), serum cholesterol (P = 0.015), triglyceride (P = 0.036), glucose (P = 0.045) level and age (P = 0.029). It did not correlate with BMI and waist circumference although it showed a moderate association between blood pressure and BMI or waist circumference. Multiple stepwise regression analysis showed systolic blood pressure to be the most powerful determinant for average brachial-ankle PWV, followed by age. Conclusions Risk factors of atherosclerosis were associated with brachial-ankle PWV in obese. However, blood pressure was still the major determinant for arterial stiffness in obese adults.

Circumferential compression of bilateral ventricles by tuberculous granuloma leading to heart failure

A 52-year-old man presented with exertional dyspnoea, leg oedema, distended jugular veins, and hepatomegaly. Chest radiography showed a right pleural effusion and calcification of pericardium (arrowhead, Figure A and B ). Echocardiography revealed compression of the …