Anatomy Question ...
As I write in AdventuresinCardiology.com, this is how the head of the electrophysiology lab at a famous east coast medical facility explains how a cardiac catheter got tangled in a mitral valve:
“If you ask how is it possible for this catheter to get caught in the mitral valve, the answer is it is possible. It occurred. And you may ask, ‘How can that possibly be?’ And the answer is, One, the atrium is a small structure. And B, (sic) all the pulmonary veins are relatively close to the mitral valve. Three, we don’t have our hands in the atrium. As a surgeon, we’re working from the leg, we’re four feet away. So you have a small structure, the heart’s beating, you have a catheter in the heart, the structures are all relatively close together, and obviously the mitral valve dipped back and caught on the catheter. One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Would a mitral valve lunge toward a catheter? What would motivate it to do so?
Thoughts and theories welcome.
Let me make one thing
Let me make one thing perfectly clear.
My groin is not four (4) feet away from my heart. Honest, I'll swear to that.
heartthrob wrote: Let me
Let me make one thing perfectly clear.
My groin is not four (4) feet away from my heart. Honest, I'll swear to that.
If the doctor says it was, it was.
Were you conscious during the surgery? I thought not - so you really don't know.
It is quite obvious from what this doctor is saying that no doctor could be held accountable; it was your heart's fault.
Did your heart damage the catheter?
And not only that, think about what your complaint is doing to his reputation and the reputation of the hospital.
Poor Heartthrob!
Poor Heartthrob!
wishandaprayer
Let me make one thing perfectly clear.
My groin is not four (4) feet away from my heart. Honest, I'll swear to that.
If the doctor says it was, it was.
Were you conscious during the surgery? I thought not - so you really don't know.
It is quite obvious from what this doctor is saying that no doctor could be held accountable; it was your heart's fault.
Did your heart damage the catheter?
And not only that, think about what your complaint is doing to his reputation and the reputation of the hospital.
oh oh - I just went to clarify that I was trying to show how ridiculous it is when doctors try to defend obvious harm that was done to patients.
The edit button is missing.
Pam - You didn't respond to my p.m. - I hope that you know that my intention was to show that
1) You were not conscious when they did the old bait and switch.
2) The doctors can try to justify their negligence, but it only makes them look bad.
3) It was NOT your fault in any way.
4) What is important here is not the catheter.
5) What is important here is not the doctor's reputation or the hospital's reputatation.
6) What is important to me is that they take accountability for the error, and learn
from it.
7) And - if they refuse to take accountability and learn from their mistakes, - people need to ask - "Is this the type of doctor or hospital that I want to go to????"
it was a rouge valve..
it was a rouge valve.. dipping back,.. did it "drop it like its hot".. hmmm... im so gonna have to ask my EP buddy how many valves tango'd with the catheter. or "dipped back"..
noonespecial wrote: it was a
it was a rouge valve.. dipping back,.. did it "drop it like its hot".. hmmm... im so gonna have to ask my EP buddy how many valves tango'd with the catheter. or "dipped back"..
Right ~ "the mitral valve dipped back and caught on the catheter." Did it lunge back? of just dip back?
How do they come up with these things? It was my valves fault!! My nasty valve jumped back and grabbed their innocent catheter!!!
John Hopkins? “If you ask
John Hopkins?
“If you ask how is it possible for this catheter to get caught in the mitral valve, the answer is it is possible. It occurred. And you may ask, ‘How can that possibly be?’ And the answer is, One, the atrium is a small structure. And B, (sic) all the pulmonary veins are relatively close to the mitral valve. Three, we don’t have our hands in the atrium. As a surgeon, we’re working from the leg, we’re four feet away. So you have a small structure, the heart’s beating, you have a catheter in the heart, the structures are all relatively close together, and obviously the mitral valve dipped back and caught on the catheter. One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
http://www.hopkinsmedicine.org/som/mission.html
So - where does this fit, exactly?
"Professionalism"
•Display the personal attributes of compassion, honesty and integrity in relationship with patients, families, and the medical community.
•Adhere to the highest ethical standards of judgment and conduct as it applies to the health care milieu.
•Demonstrate a critical self-appraisal in his/her knowledge and practice of medicine, as well as received and give constructive appraisal to/from patients, families, colleagues and other healthcare professionals.
Not in my opinion...
Perhaps lifelong learning???
wishandaprayer
Let me make one thing perfectly clear.
My groin is not four (4) feet away from my heart. Honest, I'll swear to that.
If the doctor says it was, it was.
Were you conscious during the surgery? I thought not - so you really don't know.
It is quite obvious from what this doctor is saying that no doctor could be held accountable; it was your heart's fault.
Did your heart damage the catheter?
And not only that, think about what your complaint is doing to his reputation and the reputation of the hospital.
oh oh - I just went to clarify that I was trying to show how ridiculous it is when doctors try to defend obvious harm that was done to patients.
The edit button is missing.
Pam - You didn't respond to my p.m. - I hope that you know that my intention was to show that
1) You were not conscious when they did the old bait and switch.
2) The doctors can try to justify their negligence, but it only makes them look bad.
3) It was NOT your fault in any way.
4) What is important here is not the catheter.
5) What is important here is not the doctor's reputation or the hospital's reputatation.
6) What is important to me is that they take accountability for the error, and learn
from it.
7) And - if they refuse to take accountability and learn from their mistakes, - people need to ask - "Is this the type of doctor or hospital that I want to go to????"
It's okay Wish. I thought your post was very funny - at the docs' expense, not Heartthrob's. Heartthrob cannot be relied on to know how far her groin is from her heart. She doesn't have an MD.
One way or the other, we
One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Pam
When a defendant says "one way or the other" it is the
lawyer talking! Use of this phrase denys the reader to understand the REAL reason for the event-
in other words he gave NO reason.
REminds me of my youngest years ago [he was 4]
I found him with red coloring dripping from his face - I asked what was in his mouth - he said candy...
My sister's purse was open and a bottle of Tylenol [red] was open- I was horrified - Luckily he didn't swallow it and I dragged it out of his mouth-- and he was fine
Deposition time [hahah] I asked HOW he got that pill
He said "I was walking along - and I tripped onto Auntie's purse and my mouth fell on the candy"
We had to hold back from ROFLMAO so I could punish him!
Your posting of that defense is hardly any different~
“If you ask how is it
“If you ask how is it possible for this catheter to get caught in the mitral valve, the answer is it is possible. It occurred. And you may ask, ‘How can that possibly be?’ And the answer is, One, the atrium is a small structure. And B, (sic) all the pulmonary veins are relatively close to the mitral valve. Three, we don’t have our hands in the atrium. As a surgeon, we’re working from the leg, we’re four feet away. So you have a small structure, the heart’s beating, you have a catheter in the heart, the structures are all relatively close together, and obviously the mitral valve dipped back and caught on the catheter. One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Was this one of the defendant's medical expert's testimonies? Or was this taken from the chart?
I would think that the response to this would be to find your own expert to make the appropriate medical rebuttal if you disagree with something stated.
"He said 'I was walking
"He said 'I was walking along - and I tripped onto Auntie's purse and my mouth fell on the candy'"
That's a classic.
chrisaldridge wrote: “If
“If you ask how is it possible for this catheter to get caught in the mitral valve, the answer is it is possible. It occurred. And you may ask, ‘How can that possibly be?’ And the answer is, One, the atrium is a small structure. And B, (sic) all the pulmonary veins are relatively close to the mitral valve. Three, we don’t have our hands in the atrium. As a surgeon, we’re working from the leg, we’re four feet away. So you have a small structure, the heart’s beating, you have a catheter in the heart, the structures are all relatively close together, and obviously the mitral valve dipped back and caught on the catheter. One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Was this one of the defendant's medical expert's testimonies? Or was this taken from the chart?
I would think that the response to this would be to find your own expert to make the appropriate medical rebuttal if you disagree with something stated.
WTF are you talking about? "If you disagree with something stated?"
The head of the EP Lab at The Johns Hopkins Hospital is stating for the record under oath in a deposition that a heart valve reached out and grabbed a cardiac catheter! These are the actual words of Hugh G. Calkins, MD.
How can anyone agree with such a statement? Do you Chris, believe that such a thing is possible? Do you believe that the doctor is making an honest statement?
Imalert wrote: One way or
One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Pam
When a defendant says "one way or the other" it is the
lawyer talking! Use of this phrase denys the reader to understand the REAL reason for the event-
in other words he gave NO reason.
REminds me of my youngest years ago [he was 4]
I found him with red coloring dripping from his face - I asked what was in his mouth - he said candy...
My sister's purse was open and a bottle of Tylenol [red] was open- I was horrified - Luckily he didn't swallow it and I dragged it out of his mouth-- and he was fine
Deposition time [hahah] I asked HOW he got that pill
He said "I was walking along - and I tripped onto Auntie's purse and my mouth fell on the candy"
We had to hold back from ROFLMAO so I could punish him!
Your posting of that defense is hardly any different~
OMG, Katy!!! Your son was a natural. Defense attorney in the making!! I hope he went to law school!!
"I tripped onto Auntie's purse and my mouth fell on the candy"
Of course a good law professor would have improved on that by suggesting that "The candy just may have jumped into my mouth!!"
heartthrob wrote: Imalert
One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Pam
When a defendant says "one way or the other" it is the
lawyer talking! Use of this phrase denys the reader to understand the REAL reason for the event-
in other words he gave NO reason.
REminds me of my youngest years ago [he was 4]
I found him with red coloring dripping from his face - I asked what was in his mouth - he said candy...
My sister's purse was open and a bottle of Tylenol [red] was open- I was horrified - Luckily he didn't swallow it and I dragged it out of his mouth-- and he was fine
Deposition time [hahah] I asked HOW he got that pill
He said "I was walking along - and I tripped onto Auntie's purse and my mouth fell on the candy"
We had to hold back from ROFLMAO so I could punish him!
Your posting of that defense is hardly any different~
OMG, Katy!!! Your son was a natural. Defense attorney in the making!! I hope he went to law school!!
"I tripped onto Auntie's purse and my mouth fell on the candy"
Of course a good law professor would have improved on that by suggesting that "The candy just may have jumped into my mouth!!"
Auntie is at fault because she left her purse out.
Auntie should have to give all the contents of her candy cupboard to nephew. 
heartthrob wrote: Let me
Let me make one thing perfectly clear.
My groin is not four (4) feet away from my heart. Honest, I'll swear to that.
Goodness, you must be really, really tall. Or the doctor very "short-sighted". My vote is on your side. It is only logical.
Dan Walter
“If you ask how is it possible for this catheter to get caught in the mitral valve, the answer is it is possible. It occurred. And you may ask, ‘How can that possibly be?’ And the answer is, One, the atrium is a small structure. And B, (sic) all the pulmonary veins are relatively close to the mitral valve. Three, we don’t have our hands in the atrium. As a surgeon, we’re working from the leg, we’re four feet away. So you have a small structure, the heart’s beating, you have a catheter in the heart, the structures are all relatively close together, and obviously the mitral valve dipped back and caught on the catheter. One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Was this one of the defendant's medical expert's testimonies? Or was this taken from the chart?
I would think that the response to this would be to find your own expert to make the appropriate medical rebuttal if you disagree with something stated.
WTF are you talking about? "If you disagree with something stated?"
The head of the EP Lab at The Johns Hopkins Hospital is stating for the record under oath in a deposition that a heart valve reached out and grabbed a cardiac catheter! These are the actual words of Hugh G. Calkins, MD.
How can anyone agree with such a statement? Do you Chris, believe that such a thing is possible? Do you believe that the doctor is making an honest statement?
I asked you to clarify your statement, as it wasn't clear (to me at least) who you were quoting here.
My initial statement still stands.
Are there any similiar cases in the scientific literature of the above happening previously?
Do you have an expert of your own to state that the standard of care was not met ?
I'm sorry, you must have
I'm sorry, you must have missed the main sentence, I put it right there in the first line so even the freakin' docs would get it: "As I write in AdventuresinCardiology.com, this is how the head of the electrophysiology lab at a famous east coast medical facility explains how a cardiac catheter got tangled in a mitral valve."
Hugh Calkins, MD says the "complication" never happened before. So, gee, you can't blame him. A little Google search turns up the following: To quote Hugh Calkins himself: "Because the nature of complications for cardiac catheterizations is similar, the same format for presenting complications is used to summarize these articles."
1991 "Aortic valve leaflet perforation during radiofrequency ablation." PACE Seifert MJ, Morady F, Calkins HG, Langberg JJ. Division of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109. http://www.ncbi.nlm.nih.gov/pubmed/1721146
1992: "One patient developed valvular damage as a conse-quence of catheter trauma. The patient was noted to...other complications resulted from catheter placement and manipulation. Hugh Calkins, Circulation 1992;85;1337-1346
1993 "In such a situation, the catheter should be carefully manipulated in order to avoid entrapment into the mitral valve apparatus." Hindricks G: (MERFS): complications of radiofrequency catheter ablation of arrhythmias. Eur Heart J 1993, 14:1644-1653.
1994 "Catheter entrapment in the mitral valve apparatus during radiofrequency ablation. Conte, Geiser, Curtis, Pacing Clin Electrophisiology 17:1681
1994 "Complications associated with radiofrequency catheter ablation... Valve damage." Annals of Internal Medicine
1997 The following potential adverse events are applicable to all catheterization and ablation procedures in general and are not dependent on catheter type: ... valvular damage. ... Complications associated with cardiac catheterization have been reported in the literature... valvular damage." http://tinyurl.com/CordisWebster-IFU
1998 "We describe a patient with Wolff-Parkinson-White syndrome in whom a catheter became entrapped in the mitral valve apparatus during radiofrequency ablation. Pacing Clin Electrophysiol.Apr;21(4 Pt 1):772-3.
1999 Calkins report of valve damage during catheter ablation : (Circulation. 1999;99:262-270.) 1999 “Certain risks are associated with RF ablation. They include the general risks of any cardiac catheterization, such as... valvular damage” Hein J. J. Wellens, MD http://circ.ahajournals.org/cgi/content/full/99/2/195 w/editorial specifically citing Calkins: http://circ.ahajournals.org/cgi/content/full/99/2/262)
1999 “Adverse events which may be associated with catheterization and ablation include …valvular damage.” Cardiac Pathways Chilli Cooled Ablation System Information for Use, 1999: http://www.fda.gov/cdrh/pdf/P980003c.pdf
2000 "... Damage to the mitral valve apparatus from catheter manipulation can occur." http://heart.bmj.com/cgi/content/full/84/5/553 2000 "Serious complications can occur and include valvular disruption." American College of Cardiology http://circ.ahajournals.org/cgi/content/short/102/18/2309
2001 "Complications associated with catheter ablation... may result from catheter manipulation valvular damage..." Hugh Calkins 2001;85;594-600 Heart
2001 Cardima Evaluation Study for Revelation Catheter 2001, citing work by Hugh Calkins, who was employed by the company to work on the study. “Anticipated Adverse Effects: Valve Damage”
http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4297b1_16%20-%20APPENDIX%20A%20Study%20Protocol.pdf
2001 Complications associated with catheter ablation... valvular damage... may result from catheter manipulation. Hugh Calkins: http://heart.bmj.com/cgi/content/full/85/5/594
2002 Cardima REVELATION™Tx Microcatheter System and NavAblator™ Ablation Catheter Evaluation of Radiofrequency (RF) Ablation for Atrial Fibrillation in the Right Atrium Anticipated Adverse Effects Possible adverse effects that may be anticipated in association with the investigational devices and procedure: Valve or cardiac structure damage" - Hugh Calkins
Now what is the original statement you are talking about?
“If you ask how is it possible for this catheter to get caught in the mitral valve, the answer is it is possible. It occurred. And you may ask, ‘How can that possibly be?’ And the answer is, One, the atrium is a small structure. And B, (sic) all the pulmonary veins are relatively close to the mitral valve. Three, we don’t have our hands in the atrium. As a surgeon, we’re working from the leg, we’re four feet away. So you have a small structure, the heart’s beating, you have a catheter in the heart, the structures are all relatively close together, and obviously the mitral valve dipped back and caught on the catheter. One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Was this one of the defendant's medical expert's testimonies? Or was this taken from the chart?
I would think that the response to this would be to find your own expert to make the appropriate medical rebuttal if you disagree with something stated.
WTF are you talking about? "If you disagree with something stated?"
The head of the EP Lab at The Johns Hopkins Hospital is stating for the record under oath in a deposition that a heart valve reached out and grabbed a cardiac catheter! These are the actual words of Hugh G. Calkins, MD.
How can anyone agree with such a statement? Do you Chris, believe that such a thing is possible? Do you believe that the doctor is making an honest statement?
I asked you to clarify your statement, as it wasn't clear (to me at least) who you were quoting here.
My initial statement still stands.
Are there any similiar cases in the scientific literature of the above happening previously?
Do you have an expert of your own to state that the standard of care was not met ?
wishandaprayer
One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
Pam
When a defendant says "one way or the other" it is the
lawyer talking! Use of this phrase denys the reader to understand the REAL reason for the event-
in other words he gave NO reason.
REminds me of my youngest years ago [he was 4]
I found him with red coloring dripping from his face - I asked what was in his mouth - he said candy...
My sister's purse was open and a bottle of Tylenol [red] was open- I was horrified - Luckily he didn't swallow it and I dragged it out of his mouth-- and he was fine
Deposition time [hahah] I asked HOW he got that pill
He said "I was walking along - and I tripped onto Auntie's purse and my mouth fell on the candy"
We had to hold back from ROFLMAO so I could punish him!
Your posting of that defense is hardly any different~
OMG, Katy!!! Your son was a natural. Defense attorney in the making!! I hope he went to law school!!
"I tripped onto Auntie's purse and my mouth fell on the candy"
Of course a good law professor would have improved on that by suggesting that "The candy just may have jumped into my mouth!!"
Auntie is at fault because she left her purse out.
Auntie should have to give all the contents of her candy cupboard to nephew. 
Well Wisher -- We did hire an expert witness - and
re-enacted the scene of the crime-
Auntie was give a "warning" not to leave her
purse around and....
My little darling was convicted and sentenced to
NO watching Bozo the Clown for 2 weeks
haaa haaaa
Chris: Do you have an expert
Chris: Do you have an expert of your own to state that the standard of care was not met ?
Geez Chris - stay out of court - you would be
PULVERIZED!
Let's see - the defendant states that an INANIMATE
object moved [WITHOUT HIS PERMISSION] and caused damage to the valve - therefore HE had nothing to do with it.....
Now if we could get an EXPERT VALVE
to testify in a deposition that it
can NOT happen unless being prodded
by an instrument.....
OR question the OFFENDING VALVE
under a "hot light" to get it to fess up
and say "OK OK I did it !!"
Ya got me I'm guilty-
[No offense to Pam and Dan here with my humor
- just showing Chris that the standard of care has NOTHING to do with the statement posted by the defendant}
heartthrob wrote: Let me
Let me make one thing perfectly clear.
My groin is not four (4) feet away from my heart. Honest, I'll swear to that.
Pam,
You must have been "stretched" during surgery (a little known trick that surgeons use when parts don't fit) so the 4 feet rule applied at that time. After completition of surgery the patient is shrunken back to original size. It's referred to as "S & S" in the medical circles -- a takeoff of Honey, I Shrunk the Kids.
Strawberry Jam
Let me make one thing perfectly clear.
My groin is not four (4) feet away from my heart. Honest, I'll swear to that.
Pam,
You must have been "stretched" during surgery (a little known trick that surgeons use when parts don't fit) so the 4 feet rule applied at that time. After completition of surgery the patient is shrunken back to original size. It's referred to as "S & S" in the medical circles -- a takeoff of Honey, I Shrunk the Kids.
I can't figure out how he could say that with a serious face??
Imalert wrote: My little
My little darling was convicted and sentenced to
NO watching Bozo the Clown for 2 weeks
He would have grown up to be a very successful clown, if not for that.
Let's just give thanks that Blake never crossed paths with Auntie.
Sorry Pam and Dan - this thread was about clowns, wasn't it????
Or am I hijacking again?
wishandaprayer
My little darling was convicted and sentenced to
NO watching Bozo the Clown for 2 weeks
He would have grown up to be a very successful clown, if not for that.
Let's just give thanks that Blake never crossed paths with Auntie.
Sorry Pam and Dan - this thread was about clowns, wasn't it????
Or am I hijacking again?
Look! At least I said I was
Look! At least I said I was sorry, unlike some other clown!
Dan Walter: I'm sorry, you
Dan Walter: I'm sorry, you must have missed the main sentence, I put it right there in the first line so even the freakin' docs would get it: "As I write in AdventuresinCardiology.com, this is how the head of the electrophysiology lab at a famous east coast medical facility explains how a cardiac catheter got tangled in a mitral valve."
Chris: You didn't state who you were quoting specifically by name, and I haven't been following your postings. You stated, a " head of the electrophysiology lab at a famous east coast medical facility". I wasn't aware you were referring to Dr.Calkins.
Anyways, I believe I have asked you a reasonable question. Have you retained medical experts ? I would imagine you would have, as this is standard practice in med / legal cases.
chrisaldridge wrote: Dan
Dan Walter: I'm sorry, you must have missed the main sentence, I put it right there in the first line so even the freakin' docs would get it: "As I write in AdventuresinCardiology.com, this is how the head of the electrophysiology lab at a famous east coast medical facility explains how a cardiac catheter got tangled in a mitral valve."
Chris: You didn't state who you were quoting specifically by name, and I haven't been following your postings. You stated, a " head of the electrophysiology lab at a famous east coast medical facility". I wasn't aware you were referring to Dr.Calkins.
Anyways, I believe I have asked you a reasonable question. Have you retained medical experts ? I would imagine you would have, as this is standard practice in med / legal cases.
I leave all that legal stuff to lawyers. As a layman, however, I would think that Hugh Calkins MD would be an excellent witness on informed consent. From Adventures in Cardiology: "Hugh Calkins told the FDA that pulmonary vein ablation, which he was promoting and practicing at the time, was neither safe nor sound. At the same time that his website was advertising a proven and effective procedure, he was telling government regulators that “the safety and efficacy of pulmonary vein ablation was unknown in 1998 and it is unknown now.”
So here the doctor himself admits that at the time he performed the procedure on Pam he did not know if it was safe, and he did not know if it worked.
Like I say, I'm no lawyer, but what else would you need?
Dan Walter
Dan Walter: I'm sorry, you must have missed the main sentence, I put it right there in the first line so even the freakin' docs would get it: "As I write in AdventuresinCardiology.com, this is how the head of the electrophysiology lab at a famous east coast medical facility explains how a cardiac catheter got tangled in a mitral valve."
Chris: You didn't state who you were quoting specifically by name, and I haven't been following your postings. You stated, a " head of the electrophysiology lab at a famous east coast medical facility". I wasn't aware you were referring to Dr.Calkins.
Anyways, I believe I have asked you a reasonable question. Have you retained medical experts ? I would imagine you would have, as this is standard practice in med / legal cases.
I leave all that legal stuff to lawyers. As a layman, however, I would think that Hugh Calkins MD would be an excellent witness on informed consent. From Adventures in Cardiology: "Hugh Calkins told the FDA that pulmonary vein ablation, which he was promoting and practicing at the time, was neither safe nor sound. At the same time that his website was advertising a proven and effective procedure, he was telling government regulators that “the safety and efficacy of pulmonary vein ablation was unknown in 1998 and it is unknown now.”
So here the doctor himself admits that at the time he performed the procedure on Pam he did not know if it was safe, and he did not know if it worked.
Like I say, I'm no lawyer, but what else would you need?
I know this isn't what you are asking, but if I were in Pam's situation, I know what I would "want" . . . but I can't say it here.
I understand.
I understand.