scholarly journals Aortic Valvuloplasty as Bridging for TAVI in High-Risk Patients with Heyde’s Syndrome: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Cosmo Godino ◽  
Anna Giulia Pavon ◽  
Antonio Mangieri ◽  
Alberto Margonato
Keyword(s):  
Aortic Valve ◽  
Gastrointestinal Bleeding ◽  
Aortic Valve Stenosis ◽  
Transcatheter Aortic Valve ◽  
Aortic Valvuloplasty ◽  
High Surgical Risk ◽  
Risk Patients ◽  
History Of ◽  
Heyde’S Syndrome ◽  
Valve Implantation

There is a frequent association between aortic valve stenosis and gastrointestinal bleeding, also known as Heyde’s syndrome. In these patients, the aortic valve replacement should be recommended as “gold standard.” In high-surgical-risk patients, the Transcatheter Aortic Valve Implantation (TAVI) is an alternative option. However, the risk of bleeding recurrence, related to double antiplatelet therapy started after TAVI, cannot be excluded especially in the first months. We present a case of a patient with a severe aortic valve stenosis and a history of previously documented angiodysplasia and recurrence of gastrointestinal bleeding initially treated only with balloon aortic valvuloplasty that excluded recurrence of bleeding during the subsequent six months of followup. Therefore, a definite transfemoral Edwards XT valve implantation was planned to be performed in case of recurrence of aortic stenosis.

The current diagnosis and treatment of patients with aortic valve stenosis

2021 ◽  
Author(s):  
Robert J Henning
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Calcium Score ◽  
Surgical Risk ◽  
Risk Of Death ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Artery Disease ◽  
Valve Implantation

Aortic valve stenosis (AS) is the third most frequent cardiovascular abnormality after coronary artery disease and hypertension. A bicuspid aortic valve is the most common cause for AS until seventh decade and calcific valve degeneration is responsible thereafter. In symptomatic patients, The risk of death increases from ≤1%/year to 2%/month. An echo valve area ≤1 cm2, peak transaortic velocity ≥4 m/s, mean valve gradient ≥40 mmHg and/or computerized tomography valve calcium score >2000 Agatston units (AU) for males or more than 1200 AU for females indicate severe AS. AS stages and management are discussed. Valve replacement is based on surgical risk, valve durability/hemodynamics, need for anticoagulation and patient preferences. EuroSCORE ≥20%, Society of Thoracic Surgeons Predicted Risk of Mortality ≥8% and co-morbidities indicate high surgical risk. Surgery is recommended for low-intermediate risk patients. Transcatheter aortic valve implantation is an alternative in older patients at low, intermediate, high or prohibitive risk. Transaortic valve implantation/replacement trials are summarized.

Transcatheter aortic valve implantation in a patient with suspected hereditary von Willebrand disease and severe gastrointestinal bleeding – a case report

2019 ◽  
Vol 64 (4) ◽  
pp. 142-147 ◽  
Author(s):  
Moritz Mirna ◽  
Michael Lichtenauer ◽  
Thomas Theurl ◽  
Mathias Ausserwinkler ◽  
Albert Topf ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Gastrointestinal Bleeding ◽  
Aortic Valve Stenosis ◽  
Von Willebrand Factor ◽  
Von Willebrand Disease ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Von Willebrand ◽  
Willebrand Factor

Introduction von Willebrand disease is the most common hereditary coagulopathy and is characterised by a deficiency in the quantity or quality of the von Willebrand factor. Heyde Syndrome, in contrast, is an acquired form of von Willebrand syndrome (AVWS) due to calcific aortic valve stenosis, characterised by gastrointestinal bleeding from angiodysplasia. Case presentation A 73-year-old patient presented with severe gastrointestinal bleeding and stated that she suffered from hereditary von Willebrand disease. Upon echocardiography, a severe aortic valve stenosis was found, and hence the suspicion of additional AVWS was raised. Since endoscopic interventions and conservative therapeutic approaches did not result in a cessation of the bleeding, transcatheter aortic valve implantation (TAVI) was performed to stop the additional shear stress on von Willebrand factor. This resulted in cessation of the bleeding. Conclusion Retrospectively, this life-threatening gastrointestinal bleeding was a result of severe Heyde Syndrome, which could be alleviated by TAVI. Whether the patient had suffered from inherited von Willebrand disease in the past, remains uncertain. AVWS should be considered in patients with suspected inherited von Willebrand disease and concomitant severe aortic valve stenosis, since it constitutes a treatable cause of a potentially severe bleeding disorder.

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