Embolized stent

[huasnagirl]

Is it unusual for a stent to travel from the left renal vein up through the heart and into the pulmonary artery during implantation?

[ed34]

There are various types of surgeons. Yes Cardiologists are clinical and Angioplasty but not surgery. Cardiothoracic surgeons typically deal with heart and lungs, but it depends on the training which takes 6-9 years. Some surgeons may just be cardiac, some cardiovascular some cardiovascular thoracic some just thoracic. I believe they all do a residency in general surgery first, then continue into their specialised field.

[skydnsr]

Cardiologists and heart surgeons both treat the heart, but cardiologists do it with medication and sometimes with catheter-deployed treatments, and heart surgeons do it with open-heart surgery.  Traditionally, and this is a stereotype but one that I think has a lot of truth in it, cardiologists try their utmost to avoid having their patients undergo surgery, and surgeons see cutting out the problem as the most direct solution.  Again, that is an oversimplification, and it is perhaps not fair to the most broad-minded doctors of either specialty, but a cardiologist and a heart surgeon can have distinctly different viewpoints on the same problem.  

I didn't hear you saying that you wanted money.  But in my experience, doctors are highly reluctant to even go so far as to say that they made a mistake and that they are sorry.  Rare events do happen, but something like that would be unlikely.  

Something else you should know is that doctors are trained never to criticize another doctor's work to a patient.  So it does not surprise me that the cardiologist who treated your daughter for the embolized stent did not fault the first doctor.  If you take your daughter to a pediatric heart surgeon, do not expect the surgeon to make any statements to the effect that any of her previous care was deficient.  You're just looking for an honest, expert opinion about what should be done next.

[huasnagirl]

Thank you again for your experiences and advice.  I'm glad that things worked out for you, skydnsr.  What a horrible experience.  I agree the most important thing is my daughters health.  The cardiologist she is seeing is not associated with the other doctor, however, they both belong to teaching hospitals so I think there is some loyalty there. My post came across wrong. I'm not after compensation, more like accountability and acknowledgement. I thought a cardiologist and a heart surgeon were the same thing.  I guess not?. I will look into it.

[skydnsr]

Yeah, I'm not saying not to get any legal input, but just don't necessarily expect to get a lot of satisfaction in that regard.  If you do get satisfaction, great; if you don't, you don't.  You and this child can live without that.  What's important is the child's health.  Her current doctors aren't even trying to say that this situation is risk-free for her.  They're acknowledging that new risks have been created by the mishap.  So the problem now is to compare the risks and benefits of the various medical options, from watchful waiting while on aspirin, to surgical removal of the stent, to whatever else might be an option.

[ed34]

Personally I would not want a child of mine on Aspirin every day, raising the risk for internal bleeding, even in the Brain, all because a cardiologist didn't do his job properly. They have no idea if that stent will move again, they have no idea what problems it will cause in the near, or distant future. With so many unknowns, I would want action. Before the stent gets too attached to the stent, because then it would be very difficult to remove, I would want the best surgeons to take a look and give a professional opinion. I would go to a different hospital for the opinion too, Docs do tend to stick together at times. If you are able, I would also obtain some legal advice on the matter.

[skydnsr]

That last post of mine kind of sounds like I'm on a high horse, and I don't mean it that way.  Medhelp doesn't allow us to delete or edit posts, and so let me just explain where I'm coming from:  I've been maltreated, and I was never able to hold the doctor accountable, despite the fact that I was disabled for almost two years (18 months of which was with no income) as a result of his actions.  I had to have three more surgeries to repair what he did.  Two surgeries were for burns that were inflicted on me in the operating room, and the third surgery was to redo my heart procedure.  I came within a hair's breadth of dying as a result of his incompetency, because the aortic valve that he called himself implanting in me came unsewn 2/3 of the way around.  I was walking around like that, with just a few stitches holding the valve in place.  Wide-open regurgitation, and a root/ascending pseudo-aneurysm of 5.5cm that should have been repaired in the first operation and wasn't.

There is a myth that the US court system makes it easy to obtain judgments against doctors for malpractice, but that's just it, that's a myth.  I never got one dime from the doctor, I never got an apology, and he was never censured or sanctioned or held accountable in any way for what he did to me.  

But here's what's most important.  I'm alive, because someone on a forum similar to this one helped me find my way to an expert surgeon who was able to repair the damage inside my chest.  I'm alive, I work, I live independently, and I can do pretty much anything I want to.  I'm in my right mind and didn't have any brain damage, hahah, as far as I know.  I have a close to normal life expectancy.  That's what's important.  It could have gone completely the other way.  I could not be here right now, or I could still be disabled, or I could have brain damage from the 12-hour re-operation, with over 3 hours of heart-lung bypass time, that was required to fix me.   So I choose to be grateful for the way that I was helped, and I choose to be okay with letting God take care of holding my first surgeon responsible.  It's more important to take care of the damage.  

So if a competent pediatric heart surgeon thinks that this 13 year-old child will be fine with an embolized stent in her PA, fine.  So be it.  If he thinks it needs to come out, then perhaps that's what needs to be attended to.  

End of rant.  My intention is to be helpful, so I hope you can take this in the spirit in which it's intended.  Best wishes for everything.  

[skydnsr]

Your last comment was directed to ed34, but I am going to take the liberty of responding also.  I would just go ahead and get the consultation with a heart surgeon who specializes in operating on children, preferably a renowned surgeon at a major heart center, and preferably at a center that is at least somewhat geographically and administratively removed from the child's current doctors.  The question of holding someone responsible is an entirely different one from the question of whether the child needs to have this stent surgically removed.  If you can only address one of those two concerns, which one is the priority?  You don't need to actually answer that question on this forum, but I invite you to answer it in your own mind, and take the appropriate action on the higher priority.  

[huasnagirl]

She has been seeing a pediatric cardiologist since this happened last June 2012 in what was supposed to be an outpatient procedure.  Fortunately the stent stabilized in the right pulmonary artery, however, they just released her to resume all activity, she has to take an 81mg aspirin every day and there is concern about narrowing as she ages.  Don 't you think something is very wrong here and someone should be held accountable for this.  She lost a year + of her active life and now has to see a cardiologist for the rest of her life which had nothing to do with the reason she went in in the first place.  Not to mention that the original problem will come back because the stent isn't where it is supposed to be.

[ed34]

Yes I certainly wouldn't want a blockage forming in the pulmonary system.

[skydnsr]

If I understand your post correctly, you're saying the patient can't have the stent removed, because she's only 13 years old?  There are pediatric heart centers that do open-heart surgery on children much younger than that.  I believe I would want to get a consult from a pediatric heart surgeon and see what he thinks about (a) whether it needs to come out, and (b) what are the risks.

[huasnagirl]

Thank you for you insight.  I hadn't thought about that being the cause.  Gives me something to think about and research.  Thanks again.

[ed34]

That doesn't make sense to me either. The Stent is wrapped around a tiny deflated balloon. When in position, the pressure in the balloon is increased sufficiently to push the stent firmly against the artery wall. If the pressure decided upon is wrong (too low), the stent will be loose. The balloon is then deflated before withdrawal and there is PLENTY of room for it. I'm thinking that they didn't inflate it properly.

[huasnagirl]

My understanding is that had been inflated, they were pulling out when it dislodged.  The only way to remove it is open heart surgery, which is out of the question because she is on 13.

[ed34]

Did it slip off the balloon before it was inflated? once inflated it would be very difficult for it to move.

[ed34]

yes very unusual.