Leiomyosarcoma of the pulmonary artery is a rare but potentially fatal disease. Due to its rarity, the treatment algorithm is not well-established. While there may be a role for both chemotherapy and radiotherapy, surgical management is the most definitive method. Unfortunately, when the disease process is advanced, surgery may not be curative. However, it may still be a palliative treatment option. In this case report, we present a patient who suffered from respiratory symptoms that were initially attributed to pulmonary embolism (PE). However, upon the diagnosis of pulmonary artery leiomyosarcoma (PAL), surgery intervention was undertaken and resulted in an improved quality of life for the patient.
Abstract Objective To compare post‐procedural outcomes of trans‐catheter valve replacement (TAVR) among safety‐net (SNH) and non‐safety net hospitals (non‐SNH). Background SNH treat a large population of un‐insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. Methods Adults undergoing TAVR at hospitals in the US participating in the National In‐patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity‐matched cohort of patients operated at SNH and non‐SNH institutions was analyzed, on the basis of 16 demographic and clinical co‐variates. Main outcome was all‐cause post‐procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post‐operative stay. Results Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity‐matched patient pairs. Post‐procedural mortality [OR 0.99(0.98–1.007); p = .43], stroke [OR 1.009(0.99–1.02); p = .08], acute kidney injury [OR 0.99(0.96–1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. Conclusion Post‐procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.
Introduction: Aortic dissection and aneurysm rupture are aortic emergencies. Surgical outcomes and interventional procedures have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question. Hypothesis: We hypothesized that given improved surgical mortality, there will be improvement in mortality from aortic dissection and rupture in the UK, Japan, USA, and Canada. Methods: We analyzed the WHO mortality database to determine trends in mortality from aortic dissection and rupture in 4 countries from 2000 to 2019. Crude mortality rate and age-standardized mortality rate per 100,000 persons were calculated, and annual percentage change was estimated using joinpoint regression. Results: In 2019, crude and age-standardized mortality rates from aortic dissection were 2.15 and 1.04 in UK, 8.67 and 2.66 in Japan, 1.21 and 0.76 in USA, and 1.30 and 0.67 in Canada, respectively. In 2019, crude and age-standardized mortality rates from aortic rupture were 4.86 and 1.80 in UK, 5.22 and 1.16 in Japan, 1.04 and 0.52 in USA, and 1.99 and 0.81 in Canada, respectively. There was a significantly decreasing trend in age-standardized mortality from aortic aneurysm rupture in all 4 countries over the study period, and a decreasing trend in age-standardized mortality from aortic dissection in the UK over the study period, in USA until 2010, and in Canada until 2012. There was a significantly increasing trend in mortality from aortic dissection in Japan over the study period, in the USA after 2010, and in Canada after 2012. Joinpoint regression identified significant changes in the trends from decreasing to increasing in USA and Canada. In sensitivity analyses stratified by sex, similar trends were observed. Conclusions: Trends in mortality from aortic aneurysm rupture are decreasing, however, mortality from aortic dissection is increasing in Japan, USA, and Canada. Further study to explain these trends is warranted.
