Gastrointestinal Bleeding Diagnosed by Red Blood Cell Scintigraphy in a Patient With Aortic Stenosis: A Case of Heyde Syndrome

Abstract

The authors report a case of small bowel bleeding diagnosed by Tc-99m-labeled red blood cell (RBC) scintigraphy during the postoperative period after aortic valve replacement. There is a relationship between aortic valve stenosis and gastrointestinal bleeding in elderly patients, called Heyde syndrome. The described patient had chronic anemia that worsened after surgery. RBC scintigraphy localized the source of bleeding from jejunal angiodysplasia confirmed by mesenteric angiography. This case illustrates the diagnostic information provided by RBC scintigraphy in this syndrome.

Massive jejunal bleeding due to Heyde syndrome successfully treated with double balloon endoscopy

“…Colonoscopy is useful for localization of the bleeding site when the lesions are in the colon and terminal ileum. In the case of small intestinal bleeding, Correa et al report that red blood cell scintigraphy was very useful for localization of the bleeding site [10]. In this case, capsule endoscopy revealed spurting bleeding from the angiodysplasia in the jejunum, suggesting that capsule endoscopy is also useful for the localization of the bleeding site when bleeding from the small intestine is strongly suspected.…”

“…GI bleeding occurs in the small intestine and colon in most cases of Heyde syndrome [8][9][10][11]. Colonoscopy is useful for localization of the bleeding site when the lesions are in the colon and terminal ileum.…”

“…However, emergency AVR is an operation with high mortality, especially in cases in poor general condition due to massive GI bleeding. In such risky cases, emergency therapeutic options for GI bleeding due to Heyde syndrome include endoscopic treatments, surgical bowel resection, and angiographic embolization [3,[8][9][10][11][12].…”

Intestinal angiodysplasia and aortic valve stenosis: let's not close the book on this association

“…Multimers of VWF that were 10 dimers or larger were referred to as high molecular weight multimers [48]. These multimers are needed for platelet-mediated haemostasis [12,54,59] and hence any cardiovascular disease, which causes accelerated clearance of HMW multimers of VWF, could cause bleeding from GI angiodysplasias [15].…”

“…Bleeding angiodysplasias in association with AS could also occur in mucous membranes of the nose [4,[58][59][60][61][62][63].…”