Post-Thrombotic Syndrome and Chronic Pulmonary Embolism after Obstetric Venous Thromboembolism

Objective While the majority of venous thromboembolism (VTE) during pregnancy events resolve with anticoagulation, long-term complications may occur including (1) post-thrombotic syndrome and (2) chronic pulmonary embolism. The objective of this study was to determine risk of these two complications. Study Design A retrospective cohort study using the MarketScan databases was performed on deliveries from 2008 to 2014. We identified women aged 15 to 54 years diagnosed with acute VTE during pregnancy, the delivery hospitalization, or ≤60 days postpartum who received at least one prescription postpartum for anticoagulants. Risks of (1) chronic PE and (2) post-thrombotic syndrome were evaluated for women at 6, 12, 24, and 60 months after delivery hospitalization through 2017 via the International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes. Results Of 4,267 of 4,128,900 pregnancies complicated by VTE, the majority had DVT alone (61.8%, n = 2,637), while 25.8% had PE alone (n = 1,103) and 12.4% (n = 527) had both DVT and PE. Of the entire cohort, 3,328 retained insurance coverage at 6 months, 2,823 at 12 months, 2,161 at 24 months, and 831 at 60 months. Restricted to DVT, risk of post-thrombotic syndrome was 0.7% at 6 months (n = 17), 1.1% at 12 months (n = 22), 1.7% at 24 months (n = 26), and 2.7% at 60 months (n = 16). Among women with PE diagnoses, the risk of chronic PE was 2.4% at 6 months (n = 30), 3.3% at 12 months (n = 36), 4.2% at 24 months (n = 36), and 7.2% at 60 months (n = 24). Discussion In comparison to the general population, the risk of post-thrombotic syndrome was lower. In comparison, the risk of chronic PE was similar to the estimates in the general population at comparable time points after PE events. For women with obstetric PE, it may be appropriate to be vigilant for findings and symptoms associated with chronic PE. Key Points

Performance of a 3D convolutional neural network in the detection of hypoperfusion at CT pulmonary angiography in patients with chronic pulmonary embolism: a feasibility study

Background Chronic pulmonary embolism (CPE) is a life-threatening disease easily misdiagnosed on computed tomography. We investigated a three-dimensional convolutional neural network (CNN) algorithm for detecting hypoperfusion in CPE from computed tomography pulmonary angiography (CTPA). Methods Preoperative CTPA of 25 patients with CPE and 25 without pulmonary embolism were selected. We applied a 48%–12%–40% training-validation-testing split (12 positive and 12 negative CTPA volumes for training, 3 positives and 3 negatives for validation, 10 positives and 10 negatives for testing). The median number of axial images per CTPA was 335 (min–max, 111–570). Expert manual segmentations were used as training and testing targets. The CNN output was compared to a method in which a Hounsfield unit (HU) threshold was used to detect hypoperfusion. Receiver operating characteristic area under the curve (AUC) and Matthew correlation coefficient (MCC) were calculated with their 95% confidence interval (CI). Results The predicted segmentations of CNN showed AUC 0.87 (95% CI 0.82–0.91), those of HU-threshold method 0.79 (95% CI 0.74–0.84). The optimal global threshold values were CNN output probability ≥ 0.37 and ≤ -850 HU. Using these values, MCC was 0.46 (95% CI 0.29–0.59) for CNN and 0.35 (95% CI 0.18–0.48) for HU-threshold method (average difference in MCC in the bootstrap samples 0.11 (95% CI 0.05–0.16). A high CNN prediction probability was a strong predictor of CPE. Conclusions We proposed a deep learning method for detecting hypoperfusion in CPE from CTPA. This model may help evaluating disease extent and supporting treatment planning.

NEUROMONITORING IN CLINICAL PRACTICE: WITH CEREBRAL-SOMATIC PARA INFRARED OXIMETER SYSTEM

Нейромониторинг рассматривается в широком понятии, включая динамическую оценку неврологического статуса, дискретное или непрерывное использование электрофизиологических, биохимических, ультразвуковых, рентгеновских, изотопных и других методов. Несмотря на современные технологические возможности, динамическая неврологическая оценка продолжает оставаться одним из наиболее простых и важных способов оценки адекватности интенсивной терапии. Более того, данные инструментальных методов всегда должны рассматриваться только в сопоставлении с клинической картиной. Нарастание степени угнетения сознания, глубины двигательных и тонических расстройств, увеличение числа симптомов «выпадения» ЧМН отражает неэффективность терапии. Neuromonitoring is broadly considered including dynamic neurological examination, discrete and continuous application of electrophysiological, biochemical, ultrasonic, X-ray, isotope and other methods. The dynamic neurological examination continues to remain as one of the easiest and the most important ways of adequate assessment of intensive treatment despite modern technological capabilities. Moreover, the instrumental procedure data shall be always considered just within the comparison with clinical practice. The increase of the depression of consciousness degree, the depth of movement and tonic disorders, multiplication of the incidence of SBN (Skull Brain Nerves) "loss" symptoms reflect the ineffectiveness of treatment. Cerebral - corporal para infrared oxymetrical system is suitable for estimating the patient’s (infantschildren-adults) condition with possible disorder of cerebral and/or corporal oxygenation even with keeping normal degrees of Arterial blood pressure and SpO2. rSO2 index is indicative of the balance between oxygen delivery and intake within the regions of interest. This method is used as intraoperative neuromonitoring in cases of high risk of hypoxic brain damage during surgical interventions on the vessels of the neck, surgical treatment of chronic pulmonary embolism, aneurysm and aortic dissection, as well as to assess the severity of cerebral ischemia in patients with chronic cerebral ischemia, pathology of the arteries of the head and neck, chronic pulmonary embolism. The method is based on the principle of optical spectroscopy using infrared light with a range from 650 to 1100 nm. The sensor of the device is located in the frontotemporal part at the border of the scalp. The saturation of the brain with oxygen is determined at rest in the supine position while breathing atmospheric air at all stages of surgical treatment in a continuous monitoring mode.

Differential diagnosis of acute and chronic pulmonary thromboembolism according to MSCT data

Introduction. One of the important problems of medical imaging is the differential diagnosis of patients with acute and chronic pulmonary embolism. The widely used minimally invasive technique of multispiral computed tomography with intravenous bolus contrast enhancement can serve to solve this problem, in particular, to assess the state of the parenchyma and vascular structures of the lungs.The purpose. To assess the state of bronchial arteries and parenchymal changes in the lungs in pulmonary thromboembolism based on the results of multispiral computed tomography and their role in the more precise diagnosis of this disease.Materials and methods. An analysis of CT-angiopulmonography of 600 patients with suspected PE was performed. 87 patients with confirmed pulmonary thromboembolism were selected and divided into groups according to the final diagnosis: group 1 — acute pulmonary embolism, group 2 — chronic pulmonary embolism. CT data were analyzed for the presence of pathologically changed bronchial arteries, as well as lung's parenchymal changes (including mosaic perfusion, fibrotic changes, bronchial dilatation with or without wall thickening).Results. Bronchial arteries were assessed in patients with acute and chronic pulmonary embolism and the diagnostic value of the detected changes was determined. Acute pulmonary embolism does not lead to such dilatation of the bronchial arteries as chronic pulmonary embolism. In diagnostically unclear cases, secondary parenchymal signs visible on CT (mosaic perfusion and dilated bronchi without wall thickening) can be useful in the differential diagnosis of acute and chronic pulmonary embolism.Conclusions. Most patients with chronic pulmonary embolism demonstrated dilated bronchial arteries, in contrast to patients with acute pulmonary embolism. Lung's parenchymal changes (a mosaic perfusion pattern and bronchial dilation without wall thickening) were more common in patients with chronic pulmonary embolism. These CT-signs can help differentiate acute from chronic pulmonary embolism in unclear clinical situations.