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

Abstract

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.

Multimodal Treatment and Diagnostic Modalities in the Setting of Heyde’s Syndrome: A Systematic Review

“…This resulted in three studies being eliminated, and ultimately 18 studies were included in this systematic review. Table 1 shown below is a summary of the pertinent findings of the 18 studies that were included in this systematic review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The aim of this prospective cohort was to ascertain the link between Von Willebrand factor levels and patients undergoing TAVI.…”

“…Cardiovascular: For aortic stenosis, a transthoracic echocardiogram is the modality of choice to diagnose and assess the extent of the disease [12,18]. It can visualize valve leaflets, their motion, calcification, and left ventricular function [16].…”

“…Gastrointestinal: Depending on the situation, the presence or absence of, and the degree of bleeding, multiple methods can be used to diagnose angiodysplasia [11,18]. Upper and lower GI endoscopy and colonoscopy are the primary modalities used for the diagnosis of angiodysplasia located in the upper GI tract and colon; this is in part due to the technological advancements which have aided operators by allowing them to get more precise visualization of the gastrointestinal tract [11].…”

“…For definitive management, patients need to undergo aortic valvular replacement [9,10,17,18,19] as it can lead to the normalization of high molecular weight VWF multimer levels [6,19]. Valvular replacement can be done either via surgical replacement or via TAVR [9].…”