Validation of Chest Computed Tomography Artificial Intelligence to Determine the Requirement for Mechanical Ventilation and Risk of Mortality in Hospitalized Coronavirus Disease-19 Patients in a Tertiary Care Center In Mexico City

ABSTRACT Background: Artificial intelligence (AI) in radiology has improved diagnostic performance and shortened reading times of coronavirus disease 2019 (COVID-19) patients’ studies. Objectives: The objectives pf the study were to analyze the performance of a chest computed tomography (CT) AI quantitative algorithm for determining the risk of mortality/mechanical ventilation (MV) in hospitalized COVID-19 patients and explore a prognostic multivariate model in a tertiary-care center in Mexico City. Methods: Chest CT images of 166 COVID-19 patients hospitalized from April 1 to 20, 2020, were retrospectively analyzed using AI algorithm software. Data were collected from their medical records. We analyzed the diagnostic yield of the relevant CT variables using the area under the ROC curve (area under the curve [AUC]). Optimal thresholds were obtained using the Youden index. We proposed a predictive logistic model for each outcome based on CT AI measures and predetermined laboratory and clinical characteristics. Results: The highest diagnostic yield of the assessed CT variables for mortality was the percentage of total opacity (threshold >51%; AUC = 0.88, sensitivity = 74%, and specificity = 91%). The AUC of the CT severity score (threshold > 12.5) was 0.88 for MV (sensitivity = 65% and specificity = 92%). The proposed prognostic models include the percentage of opacity and lactate dehydrogenase level for mortality and troponin I and CT severity score for MV requirement. Conclusion: The AI-calculated CT severity score and total opacity percentage showed good diagnostic accuracy for mortality and met MV criteria. The proposed prognostic models using biochemical variables and imaging data measured by AI on chest CT showed good risk classification in our population of hospitalized COVID-19 patients.

Validation of Chest Computed Tomography Artificial Intelligence to Determine the Requirement for Mechanical Ventilation and Risk of Mortality in Hospitalized Coronavirus Disease-19 Patients in a Tertiary Care Center In Mexico City.

BACKGROUND: Artificial intelligence (AI) in radiology has improved diagnostic performance and shortened reading times of coronavirus disease 2019 (COVID-19) patients' studies. OBJECTIVES: The objectives pf the study were to analyze the performance of a chest computed tomography (CT) AI quantitative algorithm for determining the risk of mortality/mechanical ventilation (MV) in hospitalized COVID-19 patients and explore a prognostic multivariate model in a tertiary-care center in Mexico City. METHODS: Chest CT images of 166 COVID-19 patients hospitalized from April 1 to 20, 2020, were retrospectively analyzed using AI algorithm software. Data were collected from their medical records. We analyzed the diagnostic yield of the relevant CT variables using the area under the ROC curve (area under the curve [AUC]). Optimal thresholds were obtained using the Youden index. We proposed a predictive logistic model for each outcome based on CT AI measures and predetermined laboratory and clinical characteristics. RESULTS: The highest diagnostic yield of the assessed CT variables for mortality was the percentage of total opacity (threshold >51%; AUC = 0.88, sensitivity = 74%, and specificity = 91%). The AUC of the CT severity score (threshold > 12.5) was 0.88 for MV (sensitivity = 65% and specificity = 92%). The proposed prognostic models include the percentage of opacity and lactate dehydrogenase level for mortality and troponin I and CT severity score for MV requirement. CONCLUSION: The AI-calculated CT severity score and total opacity percentage showed good diagnostic accuracy for mortality and met MV criteria. The proposed prognostic models using biochemical variables and imaging data measured by AI on chest CT showed good risk classification in our population of hospitalized COVID-19 patients.

Initial experience in Mexico with the Evolut™ R valve with direct aortic Access.

Background: Aortic stenosis (AS) is one of the most frequent valvulopathies in elderly patients. The treatment for AS is heart surgery; however, many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve implantation (TAVI) was developed for these patients. Objective: To disseminate the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to the rapid growth in technology and knowledge, there is a lot of experience with TAVI already. Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought after, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar, and easy to learn for cardiac surgeons. Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding and risk of myocardial injury) and shorter length of stay in the intensive care unit compared to surgery or transapical access. Conclusions: Our center successfully implanted the self-expandable aortic valve Evolut™ through direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.

Antecedentes: La estenosis aórtica es una de las valvulopatías más frecuentes en el paciente mayor. Su tratamiento es la cirugía de corazón, sin embargo, muchos pacientes no se benefician de este tratamiento por considerarse de alto riesgo quirúrgico o inoperables. Para estos últimos pacientes se desarrolló el implante de válvula aórtica transcatéter (TAVI). Objetivo: Dar a conocer la factibilidad y seguridad de otras vías de acceso para la implantación de válvulas aórticas transcatéter y que además se puede realizar en el laboratorio de hemodinámica. Además de un rápido crecimiento en tecnología y conocimientos, actualmente ya se tiene mucha experiencia con TAVI. Metodología: Una de las limitantes es el diámetro de los accesos vasculares femorales, subclavio y axilar. Es por esto por lo que se buscan otros accesos como el aórtico directo, a pesar del carácter invasivo de la minitoracotomía y aortotomía es técnicamente factible, familiar y fácil de aprender para los cirujanos cardíacos. Resultado: Se ha asociado con resultados favorables y una menor tasa de complicaciones (sangrado, riesgo de lesión miocárdica) y menor duración de la estancia en la Unidad de Cuidados Intensivos en comparación con la cirugía o el acceso transapical. Conclusión: Nuestro centro implantó con éxito la válvula aórtica autoexpandible Evolut™ vía aórtica directa por presentar una disección en la aorta transversa con posibilidades de embolización.

Experiencia inicial en México con la prótesis aórtica transcatéter Evolut™ R por abordaje aórtico directo.

Background: Aortic stenosis is one of the most frequent valvulopathies in the elderly patient. The treatment for aortic stenosis is heart surgery, however many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve (TAVI) was developed for these patients. Objective: To make known the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to rapid growth in technology and know-how, TAVI is already very experienced. Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar and easy to learn for cardiac surgeons. Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding, risk of myocardial injury) and shorter length of stay in the Intensive Care Unit compared to surgery or transapical access. Conclusion: Our center successfully implanted the self-expandable aortic valve Evolut™ via direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.

Antecedentes: La estenosis aórtica es una de las valvulopatías más frecuentes en el paciente mayor. Su tratamiento es la cirugía de corazón, sin embargo, muchos pacientes no se benefician de este tratamiento por considerarse de alto riesgo quirúrgico o inoperables. Para estos últimos pacientes se desarrolló el implante de válvula aórtica transcatéter (TAVI). Objetivo: Dar a conocer la factibilidad y seguridad de otras vías de acceso para la implantación de válvulas aórticas transcatéter y que además se puede realizar en el laboratorio de hemodinámica. Además de un rápido crecimiento en tecnología y conocimientos, actualmente ya se tiene mucha experiencia con TAVI. Metodología: Una de las limitantes es el diámetro de los accesos vasculares femorales, subclavio y axilar. Es por esto por lo que se buscan otros accesos como el aórtico directo, a pesar del carácter invasivo de la minitoracotomía y aortotomía es técnicamente factible, familiar y fácil de aprender para los cirujanos cardíacos. Resultado: Se ha asociado con resultados favorables y una menor tasa de complicaciones (sangrado, riesgo de lesión miocárdica) y menor duración de la estancia en la Unidad de Cuidados Intensivos en comparación con la cirugía o el acceso transapical. Conclusión: Nuestro centro implantó con éxito la válvula aórtica autoexpandible Evolut™ vía aórtica directa por presentar una disección en la aorta transversa con posibilidades de embolización.

Experiencia inicial en México con la prótesis aórtica transcatéter Evolut R por abordaje aórtico directo / Initial experience in Mexico with the EvolutTM R valve with direct aortic access

Resumen Antecedentes: La estenosis aórtica es una de las valvulopatías más frecuentes en el paciente mayor. Su tratamiento es la cirugía de corazón, sin embargo, muchos pacientes no se benefician de este tratamiento por considerarse de alto riesgo quirúrgico o inoperables. Para estos últimos pacientes se desarrolló el implante de válvula aórtica transcatéter (TAVI). Objetivo: Dar a conocer la factibilidad y seguridad de otras vías de acceso para la implantación de válvulas aórticas transcatéter y que además se puede realizar en el laboratorio de hemodinámica. Además de un rápido crecimiento en tecnología y conocimientos, actualmente ya se tiene mucha experiencia con TAVI. Metodología: Una de las limitantes es el diámetro de los accesos vasculares femorales, subclavio y axilar. Es por esto por lo que se buscan otros accesos como el aórtico directo, a pesar del carácter invasivo de la minitoracotomía y aortotomía es técnicamente factible, familiar y fácil de aprender para los cirujanos cardíacos. Resultado: Se ha asociado con resultados favorables y una menor tasa de complicaciones (sangrado, riesgo de lesión miocárdica) y menor duración de la estancia en la Unidad de Cuidados Intensivos en comparación con la cirugía o el acceso transapical. Conclusión: Nuestro centro implantó con éxito la válvula aórtica autoexpandible Evolut vía aórtica directa por presentar una disección en la aorta transversa con posibilidades de embolización.

Abstract Background: Aortic stenosis is one of the most frequent valvulopathies in the elderly patient. The treatment for aortic stenosis is heart surgery, however many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve (TAVI) was developed for these patients. Objective: To make known the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to rapid growth in technology and know-how, TAVI is already very experienced. Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar and easy to learn for cardiac surgeons. Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding, risk of myocardial injury) and shorter length of stay in the Intensive Care Unit compared to surgery or transapical access. Conclusion: Our center successfully implanted the self-expandable aortic valve Evolut via direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.

Management of orbital emphysema secondary to rhegmatogenous retinal detachment repair with hyperbaric oxygen therapy.

PURPOSE: To describe the case of orbital subcutaneous emphysema who was successfully treated with hyperbaric oxygen therapy. OBSERVATIONS: Case report. Retrospective analysis of medical records and computer tomography images. A 40 years-old female, with retinal detachment who was seen at the emergency department, two weeks after undergoing a combined procedure of pars plana vitrectomy, scleral buckle and Sulfur hexafluoride tamponade. The patient complained of pain, decrease eye movement and edema of the upper eyelid. Clinical examination revealed periorbital crepitus. She was treated immediately with soft tissue decompression with small-gauge needle. Orbital emphysema recurred quickly, indicating possible gas trapped in the soft tissue. Using the US NAVY decompression protocol we were able to achieve fast clinical improvement. The protocol was repeated in several occasions until complete resolution. CONCLUSION AND IMPORTANCE: Hyperbaric oxygen therapy is an effective treatment for orbital and periorbital emphysema, due to its property of helping accelerate N2 elimination from adipose tissue.

[Experience of transcatheter aortic valve implantation in the Central Military Hospital]. / Experiencia de la implantación de válvulas aórticas transcatéter en el Hospital Central Militar.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for patients with severe symptomatic aortic stenosis, inoperable or at high surgical risk. The purpose of this communication is to report the results of the experience of this new technique and compare them with literature. METHODS: Review of 17 patients data with symptomatic severe aortic stenosis at high surgical risk or inoperable, treated with a transcatheter implantation aortic valve (TAVI) via femoral surgical access with Core Valve (Medtronic, EE.UU.) between September 2013 and July 2014. RESULTS: All patients had severe aortic stenosis with a mean gradient of 46̊æ14 mmHg received CoreValveTM (Medtronic, USA). Half of patients was performed under general anesthesia, the other half with regional and local anesthesia. In-hospital mortality was 11.7% and one death in follow-up from September 2013 until the time of preparing this report (5.9%).Total mortality at one year follow-up was 17.6%. The technical success rate was 82.4%, with an immediate post-implantation gradient of 5.4̊æ3.4 mmHg. Aortic regurgitation I degree was observed in 5 patients (29.4%); 2 patients (11.7%) had aortic regurgitation grade II. Post dilatation was made in 6 patients (35.2%). We did not have any vascular complications. Permanent pacemaker implantation was needed in 6 patients (35.2%). One patient complicated with acute renal failure, 2 had in-hospital ischemic stroke (11.7%), none had need for cardiac surgery; 2 patients had major bleeding complications that required transfusion. CONCLUSIONS: In patients with high surgical risk or inoperable, TAVI is a treatment option that improves life quality, survival and diminsh the need of hospitalizations. There can be some complications and even death, so that a proper patient selection and a multidisciplinary team is needed and fundamental for a successful procedure.