Sangramento gastrintestinal por angiodisplasia e estenose aórtica: síndrome de Heyde

Abstract

There is a frequent association between aortic valve stenosis and gastrointestinal bleeding, also known as Heyde's syndrome. The pathophysiologic basis for this syndrome seems to be an acquired von Willebrand factor deficiency, leading to bleeding of angiodysplastic arteriovenous malformations. Treatment options include the location and cauterization of bleeding points, which is associated to high recurrence rates. Valve replacement appears to offer the best hope of long-term resolution of bleeding, and should be considered in most cases. We report a 79 year-old patient with aortic stenosis and gastrointestinal bleeding due to duodenal angiodysplasia treated by transcatheter aortic valve implantation.

Heyde's Syndrome and Transcatheter Aortic Valve Implantation

“…3-5,7,8 VWF is secreted by blood endothelial cells, contributing to the formation of platelet thrombi and acting as a mediator of platelet adhesion in the vascular lesion site. 5 …”

“…The pathophysiology of the condition is explained by the passage of vWF through the stenotic valve, with multimer proteolysis through the enzyme ADAMTS13, a proteinase that acts especially in situations of high shear stress. 3 - 5 , 7 , 8 VWF is secreted by blood endothelial cells, contributing to the formation of platelet thrombi and acting as a mediator of platelet adhesion in the vascular lesion site. 5 …”