Increased Prevalence of Aortic Stenosis in Patients With Arteriovenous Malformations of the Gastrointestinal Tract in Heyde Syndrome

Batur, Pelin; Stewart, William J.; Isaacson, J. Harry

doi:10.1001/archinte.163.15.1821

Cited by 82 publications

(61 citation statements)

References 20 publications

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“…Rheumatic disease, congenital abnormalities, active infective endocarditis, metabolic or enzymatic abnormalities such as gout or whipples massive annular calcification [3] The severity of MS can be broken down into: mild with gradient of 8mm Hg, moderate with gradient 8 to 12 mm Hg and severe with gradient 12mm Hg or higher [4]. According to the data we gathered, there is no association between MS and angiodysplasia or GI bleeding.…”

Section: Ms Is Caused By Five Main Conditionsmentioning

confidence: 99%

Is mitral stenosis associated with gastrointestinal bleeding: A twist on Heyde’s Syndrome

James¹,

Vyas²,

Alkhawam³

et al. 2017

Cardiovasc Disord Med

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Introduction: Heyde's syndrome is the link between Aortic stenosis (AS) and angiodysplasia leading to Gastrointestinal (GI) bleed. There have been multiple cases and theories leading to this phenomenon, including the loss of von Willebrand factor (vWF) through shear factor of a stenotic valve. This association is further validated by the cessation of GI bleed after aortic valve replacement. The question posed is, if AS can lead to GI bleeding through loss of vWF or other mechanisms, would mitral stenosis (MS) cause a similar presentation?

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Section: Ms Is Caused By Five Main Conditionsmentioning

confidence: 99%

Is mitral stenosis associated with gastrointestinal bleeding: A twist on Heyde’s Syndrome

James¹,

Vyas²,

Alkhawam³

et al. 2017

Cardiovasc Disord Med

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show abstract

“…It has been termed as 'Heyde's syndrome' (HS) [1,9,12]. Boss and Rosenblum reported the first case of bleeding colonic angiodysplasia and autopsy-proven aortic stenosis in 1971 [13].…”

Section: Historymentioning

confidence: 99%

“…Angiodysplasias are arterio-venous malformations and commonly cause gastrointestinal (GI) bleeding in the elderly [1]. Some authors report that patients with aortic valve stenosis (AS) have an increased prevalence of angiodysplasias of the gastrointestinal tract [1].…”

Section: Introductionmentioning

confidence: 99%

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

Mishra¹,

Kováč²,

Caestecker³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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SummaryThe association between gastrointestinal (GI) bleeding due to angiodysplasia of the large intestine and calcific aortic stenosis (AS) has been a matter of debate. Recent studies suggest that this association is related to subtle alterations in plasma coagulation factors. von Willebrand factor is the strongest possible link between aortic stenosis and bleeding associated with GI angiodysplasia. Physicians should be aware of this entity when dealing with elderly patients presenting either with GI bleeding or with AS. A high index of suspicion and appropriate diagnostic procedures followed by prompt treatment could be life saving. Several questions related to the pathogenesis and optimal management remain unanswered. Aortic valve replacement appears to offer the best hope of long-term resolution of the bleeding, and should be considered in most cases. The association between chronic gastrointestinal bleeding in elderly patients and aortic stenosis becomes more relevant with the advent of transcatheter aortic valve implantation which can be offered even to elderly patients with comorbidities which could make conventional surgery impossible. #

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“…In addition, these patients are very often on anticoagulants or anti-platelets which increase the bleeding tendency of the vascular lesions [8]. Patients with aortic stenosis have a higher tendency to have SBAs [9]. In this phenomenon there is an increased consumption of high molecular weight multimers of von Willebrand Factor (vWF) due to high shear forces across the stenotic aortic valve thus predisposing patients to bleeding [10].…”

Section: Introductionmentioning

confidence: 99%

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

Zammit

Sidhu

Sanders

2017

JGLD

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Background & Aims: Patients with small bowel angioectasias (SBAs) can be difficult to manage as they are generally elderly with multiple co-morbidities. Angioectasias are multiple and tend to recur. Argon plasma coagulation (APC), despite being a commonly used method to treat these patients has an associated persistent rate of re-bleeding necessitating additional treatment to manage these patients.Methods: All patients with refractory iron deficiency anaemia secondary to SBAs were retrospectively subdivided into two groups. Patients in group 1 were managed with double balloon enteroscopy (DBE) and APC alone and those in group 2 received Lanreotide in addition to DBE and APC.Results: A total of 49 patients were included in this study: group 1: 37 patients (75.5%), group 2: 12 patients (24.5%). All had significant comorbidities and the mean duration of anaemia was 114.3, SD 307.0 months. Significant improvements in haemoglobin (Hb) (11g/L vs 3.2g/L p=0.043), transfusion requirements per month (0.8 vs 4.7 p=0.052) and mean bleeding episodes (1.08 vs 2.6 p=0.032) were demonstrated in group 2 when compared to group 1. One patient developed symptomatic gallstone disease and one patient stopped Lanreotide due to a lack of response.Conclusions: This is the first study comparing endotherapy to a combination of endotherapy and pharmacotherapy. It shows a significantly better outcome in patients receiving a combination of endotherapy and Lanreotide. Lanreotide can be a safe additional treatment in patients not responding to APC alone.Abbreviations: APC: argon plasma coagulation; CE: capsule endoscopy; DBE double balloon enteroscopy; Hb: hemoglobin; OGIB: over gastrointestinal bleeding; SBAs: small bowel angioectasias.

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Increased Prevalence of Aortic Stenosis in Patients With Arteriovenous Malformations of the Gastrointestinal Tract in Heyde Syndrome

Abstract: Our study confirmed an association between AVMs and AS, although the etiology of the Heyde syndrome remains unclear. Clinicians need to be aware of this syndrome because it may affect their management of patients with gastrointestinal bleeding or AS.

Cited by 82 publications

References 20 publications

Is mitral stenosis associated with gastrointestinal bleeding: A twist on Heyde’s Syndrome

Is mitral stenosis associated with gastrointestinal bleeding: A twist on Heyde’s Syndrome

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

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

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