complications after surgery

  Dear Sir or Madam,
  My father had a mitral valve replacement this past December, and this was a long and complicated case which I will try to abbreviate as much as I can. The original procedure that was being performed was shaving of the enlarged prostate.This turned into a Urinary tract infection which was not properly treated and then resulted into SEPSIS which in turn caused the endocarditis.My father is 68 yrs old, and was never sick a day in his life. He was 5'6" and about 230 lbs.
  He had a St. Judes valve installed . There was significant fluid retention that was diagnosed by an echo-cardiogram that There were complications that resulted in a second surgery 10 days following the initial surgery, in which a suture had broken through the tissue that it was sewn to , and therefore
  they had to repair the way it was seated in the heart.That went fine and he was finally recovering somewhat better than earlier .
  He was on heavy doses of varying intravenous antibiotics for a couple of months, and he was still retaining fluids. They checked all possible causes,(liver,kidneys,protein levels, etc). He was treated with lasix and other diuretics, and they finally did relieve the fluid . That was about 4 weeks ago. He has been home and on the road to recovery, he had lost 50+ pounds while in the hospital, and has finished taking anti-biotics.
  The past two days, he has gained about 20 pounds of fluid, and he was admitted into the hospital again. He is at the U of P hospital in Philadelphia.
  Our family is very worried about his condition and we are baffled as are the doctors at U of P as to why he is retaining this fluid. Could this be related to the cumadin (coumadin) levels ? I would appreciate any advice you could give , or if you know of any similar cases that we can relate to this case.We are at an utter stand still my father's condition.
   Thank You , I hope you can help. Please let me know if I can provide you with any more information.
                                    Sincerley,
                                              Stef

[CCF Cardio MD-SGM]

Dear Stef,  
Indeed, you describe a difficult problem.  Leaving the complicated history aside,  I'll focus on the question of fluid buildup, especially in cardiac patients who have undergone surgery.  Fluid can accumulate in the body due to diverse causes, several of which are heart-related.  Dysfunction of the left and/or right side of the heart can cause a fluid backup which manifests as shortness of breath or edema (swollen ankles, for example).  This heart dysfunction can be due to either compromised pumping of the heart's ventricles, or can be related to disorders of the valves, to name a few causes.  I'm assuming that the valve is functioning well, but I wouldn't be surprised if your father has dysfunction of the pumping action of the right or left heart.  This is not atypical in the setting of mitral valve disease, and often reveals itself only after the surgery is done.  There is much discussion in the cardiology literature about optimal timing of valve replacement surgery, in order to perform the procedure early enough to avoid irreversible pump dysfunction, but not so early as to expose the patient to unnecessary risks.  I don't know where in the course of his mitral valve disease your father had his surgery.
If the extensive tests done at HUP do not point to a non-cardiac cause for this problem,  it is likely related to cardiac dysfunction.  This can be relatively easily ascertained through the performance of an echocardiogram-- which I'm certain has been done.  I recommend that you discuss with your father's physicians the specific reasons that underlie his fluid buildup and the general deterioration of his condition.  There are good treatments for heart failure, which may well be present in this case, although the disease is chronic and recurring.
Regarding the coumadin, this does not cause fluid accumulation.  However, it is an essential element of management following mechanical heart valve replacement.    In closing,   I believe that the physicians at the Univ. of Pennsylvania are finely qualified to manage this problem, however we would be glad to see your father in consultation at the Cleveland Clinic if you so desire.  Feel free to call 1- 800 CCF CARE to make an appointment with Dr. Stewart or Dr. Griffin at Desk F15.
Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies should only be sought from a physician directly involved in your care.