Complications of gynecologic surgery in patients with prosthetic heart valves

Thirty-three patients with prosthetic heart valves, who underwent surgical procedures at Hacettepe University Hospital Department of Obstetrics and Gy necology between October 1993 and October 1997, were retrospectively review ed. The most common indication for surgical intervention was abnormal uteri ne bleeding (57.5%) associated with anatomic causes such as uterine leimyom a and endometrial hyperplasia. Perioperative practice basically involved su bstituting low-molecular-weight heparin for coumadin therapy in elective ca ses or infusion of fresh-frozen plasma to correct coagulopathy in emergency cases. One patient (3.0%) developed serious intraabdominal bleeding follow ing total abdominal hysterectomy with bilateral salpingo-oophorectomy. A re laparotomy, including bilateral hypogastric artery ligation, was performed. Four cases (12.1%) of superficial wound hematomas were observed, but all w ere managed conservatively. There was no postoperative thromboembolic event , or mortality. The cardiovascular complications encountered in the postope rative period were heart failure in two (6.0%) and ischemic electrocardiogr aphic changes in four (12.1%) patients. Substituting low-molecular-weight h eparin for coumadin proved to be effective against life-threatening periope rative thromboembolism. However, a significant number of patients with pros thetic valves undergoing gynecologic surgery experienced postoperative blee ding. Cardiovascular complications such as heart failure and ischemia were also encountered. In view of these possible consequences, this patient grou p should be regarded as a high-risk group, and multidisciplinary evaluation should be made.