The development of the latest generation of durable left ventricular assist devices (LVAD) drastically decreased adverse events such as pump thrombosis or disabling strokes. However, time-related complications such as aortic insufficiency (AI) continue to impair outcomes following durable LVAD implantation, especially in the context of long-term therapy. Up to one-quarter of patients with durable LVAD develop moderate or severe AI at 1 year and its incidence increases with the duration of support. The continuous regurgitant flow within the left ventricle can compromise left ventricular unloading, increase filling pressures, decrease forward flow and can thus lead to organ hypoperfusion and heart failure. This review aims to give an overview of the epidemiology, pathophysiology, and clinical consequences of AI in patients with durable LVAD.
Pulmonary artery (PA) sarcoma is a rare tumor with an overall poor prognosis. It can often be misdiagnosed due to its nonspecific presentation and its similitude to pulmonary embolism on imaging. We, herein, describe the case of a 60-year-old male with a primary PA sarcoma for which a surgical approach was undertaken. Due to the low incidence of PA and therefore the absence of clear guidelines on the management of this disease, we also present a succinct literature review on the subject. K E Y W O R D S aorta and great vessels, cardiovascular pathology 1 | INTRODUCTION Primary cardiac tumors are present in 0.001%-0.3% of conducted autopsies. 1 Among these, 25% are malignant, with the majority being sarcomas. 1 Pulmonary artery (PA) sarcoma can be misdiagnosed due the low incidence of the disease and to its nonspecific presentation. 2 The mass is often mistaken for a pulmonary embolus (PE) on imaging studies further delaying correct diagnosis and treatment and contributing to the poor prognosis associated with PA sarcoma. 2 This paper presents both the case of a 60-year-old male with a PA sarcoma for which surgical management was undertaken and a succinct literature review on the subject. We obtained fully informed verbal consent from the patient, as well as a waiver from the Institutional Review Board. CALIN ET AL. | 365 an improved survival for those undergoing postoperative radiotherapy and chemotherapy (28 months vs. 8 months, p = .042). 8 However, not all literature agrees on the subject. In a case series by Wong et al., 2 no statistically significant difference (p = .34) was seen between the triple therapy (OS 24 months; n = 4) and single or double-modality therapy (OS 8 months; n = 7). 2 In a case series of 31 patients undergoing surgery, 18 patients received adjuvant treatment: 15 underwent chemotherapy, 2 radiotherapy, and 1 patient received both. 5 It was concluded that there was no significant statistical difference between the groups. 5 Therefore, the effectiveness of adjuvant therapy remains equivocal in the present. This report presents one of the rare cases in which PA sarcoma was rapidly diagnosed without being mistaken as a PE. This might be explained by the mass location, which seemed to already invade the mediastinum on the CT scan, rather than occupy solely the intraarterial space, as a thrombus would. This case is also a great depiction of the importance of interdisciplinary approach to the management of a rare disease. 4 | CONCLUSION In summary, PA sarcoma is a rare and aggressive malignancy. Early diagnosis is paramount, but incredibly challenging. Metastases are often present upon diagnosis further decreasing an already dismal survival rate. Surgical treatment is deemed the mainstay of treatment of PA sarcoma, considerably improving survival. However, to date, there is no consensus about the use of adjuvant therapy.
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