JOURNAL OF GYNECOLOGIC SURGERY, cilt.15, ss.81-85, 1999 (SCI İndekslerine Giren Dergi)
Thirty-three patients with prosthetic heart valves, who underwent surgical procedures at Hacettepe University Hospital Department of Obstetrics and Gynecology between October 1993 and October 1997, were retrospectively reviewed. The most common indication for surgical intervention was abnormal uterine bleeding (57.5%) associated with anatomic causes such as uterine leimyoma and endometrial hyperplasia. Perioperative practice basically involved substituting low-molecular-weight heparin for coumadin therapy in elective cases or infusion of fresh-frozen plasma to correct coagulopathy in emergency cases. One patient (3.0%) developed serious intraabdominal bleeding following total abdominal hysterectomy with bilateral salpingo-oophorectomy. A relaparotomy, including bilateral hypogastric artery ligation, was performed. Four cases (12.1%) of superficial wound hematomas were observed, but all were managed conservatively. There was no postoperative thromboembolic event, or mortality. The cardiovascular complications encountered in the postoperative period were heart failure in two (6.0%) and ischemic electrocardiographic changes in four (12.1%) patients. Substituting low-molecular-weight heparin for coumadin proved to be effective against life-threatening perioperative thromboembolism. However, a significant number of patients with prosthetic valves undergoing gynecologic surgery experienced postoperative bleeding. Cardiovascular complications such as heart failure and ischemia were also encountered. In view of these possible consequences, this patient group should be regarded as a high-risk group, and multidisciplinary evaluation should be made.