A surgical case of aortic stenosis with recurrent gastrointestinal bleeding: Heyde syndrome

Iijima, Makoto; Itoh, N; Murase, Ryota; Makino, Yutaka

doi:10.1016/j.ijscr.2018.10.078

Cited by 14 publications

(11 citation statements)

References 12 publications

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“…However, in patients with severe aortic stenosis, GI bleeding in the absence of angiodysplasias has been reported. These patients are referred to as 'GI bleeding not related to angiodysplasias' [6]. Our case was similar without identifiable angiodysplasias on endoscopy.…”

Section: Discussionsupporting

confidence: 50%

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Ahmed

Haque

2020

Cureus

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The association of severe aortic stenosis and gastrointestinal (GI) bleeding is a well-known phenomenon. The pathogenesis involves an acquired deficiency of von Willebrand factor (vWF) due to shear stress resulting in alteration of vWF morphology. This results in inappropriate cleavage of vWF multimers into smaller dysfunctional fragments. Patients with atrial fibrillation and high thrombotic risk require anticoagulation for stroke prophylaxis. We describe a case of severe intermittent GI bleeding in a patient with atrial fibrillation while being on warfarin and other novel anticoagulants. This case highlights the role of severe aortic stenosis and resultant acquired vWF deficiency in complicating decision making in patients with a need for anticoagulation due to high thrombotic risk.

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Section: Discussionsupporting

confidence: 50%

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Ahmed

Haque

2020

Cureus

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“…Various other studies have shown similar laboratory deviations in patients with aortic valve stenosis (12,27), dysfunctional aortic or mitral valve replacement, severe aortic or mitral valve regurgitation (28,29) and in patients with acquired von Willebrand syndrome type 2A (30). It was also reported that the altered laboratory parameters normalized after the repair of an aortic valve stenosis (30)(31)(32).…”

Section: Discussionmentioning

confidence: 69%

Hemostatic abnormalities in adult patients with Marfan syndrome

Kornhuber¹,

Seidel²,

Pujol³

et al. 2019

Cardiovasc. Diagn. Ther.

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Background: Aortic root ectasia might induce hemostatic disorders in patients with Marfan syndrome (MFS) via altered blood flow and rheology. The aim of this study was to explore the hemostasis in patients with MFS compared with healthy controls.Methods: In this cross-sectional case-control study we included patients with verified MFS (n=51) and sexand age-matched healthy controls (n=50). Main criteria were the aortic root in echocardiography and cardiac magnetic resonance imaging (MRI), and the coagulation status.Results: When compared with healthy controls, patients with MFS showed significantly increased diameters of the aortic roots (43.0±7.72 vs. 28.8±3.74 mm, P<0.001) and aortic Z-scores (4.36±2.77 vs. 0.948±1.09, P<0.001), considerably higher values of Multiplate ® tests (e.g., MP-ADP: 878.4±201.7 vs.

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“…It reduces the mechanical shear stress on the HMW vWF multimers inhibiting their cleavage by ADAMTS13 and consequently improves coagulation abnormalities implicated in Heyde's syndrome. There are several observational studies that have demonstrated potential therapeutic benefits of AVR [45][46][47][48][49][50][51][52][53]. All studies were published between 2010 and 2020; cessation of gastrointestinal bleeding following AVR was the most measured outcome.…”

Section: Aortic Valve Replacementmentioning

confidence: 99%

Reappraising the spectrum of bleeding gastrointestinal angioectasia in a degenerative calcific aortic valve stenosis: Heyde’s syndrome

2021

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Background The occurrence of bleeding gastrointestinal angioectasia in elderly patients with degenerative calcific aortic stenosis is one of the most challenging clinical scenarios. A number of studies have shown that this clinical phenomenon is known as Heyde’s syndrome. Main body of the abstract The pathogenesis of Heyde’s syndrome is mainly due to the loss of high-molecular-weight von Willebrand factor (HMW vWF) multimers, as a consequent fragmentation of HMW vWF multimers as they pass through the stenosed aortic valve leading to acquired von Willebrand syndrome type IIA. Aortic valve replacement has proven to be a more effective management approach in the cessation of recurrent episodes of gastrointestinal bleeding. Short conclusion Physicians should have a high index of suspicion when dealing with elderly patients with established aortic stenosis presenting with iron deficiency anemia or unclear gastrointestinal bleeding. Parallel consultations between different specialties are essential for appropriate management.

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A surgical case of aortic stenosis with recurrent gastrointestinal bleeding: Heyde syndrome

Cited by 14 publications

References 12 publications

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Hemostatic abnormalities in adult patients with Marfan syndrome

Reappraising the spectrum of bleeding gastrointestinal angioectasia in a degenerative calcific aortic valve stenosis: Heyde’s syndrome

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