scholarly journals Recurrent Gastrointestinal Bleeding in a Patient With Severe Aortic Valve Stenosis: A Diagnosis of Heyde’s Syndrome

Cureus ◽  
2021 ◽  
Author(s):  
Adham E Obeidat ◽  
Jean Kim
Keyword(s):  
Aortic Valve ◽  
Gastrointestinal Bleeding ◽  
Aortic Valve Stenosis ◽  
Heyde’S Syndrome

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.

Association of aortic valve stenosis and recurrent gastrointestinal bleeding

2012 ◽  
Vol 19 (2) ◽  
pp. 122-124
Author(s):  
Idalia J.J. van Hul ◽  
Veerle Schwagten ◽  
Inge Vrelust
Keyword(s):  
Aortic Valve ◽  
Gastrointestinal Bleeding ◽  
Aortic Valve Stenosis

Report of a Case of Heyde's Syndrome Diagnosed by Abnormal Closure Times Despite Normal Von Willebrand's Activity

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1403-1403
Author(s):  
Pernilla D'Souza ◽  
Mark Blostein
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Gastrointestinal Bleeding ◽  
High Shear ◽  
Life Threatening ◽  
Cofactor Activity ◽  
Heyde’S Syndrome ◽  
Von Willebrand ◽  
Ristocetin Cofactor ◽  
Ristocetin Cofactor Activity

Abstract Abstract 1403 In 1958, EC Heyde described a syndrome of iron deficiency anemia due to gastrointestinal bleeding (GI) in a patient with calcific aortic stenosis. In 1992, Warkentin et al. hypothesized a bleeding diathesis due to a link between Heyde's Syndrome and acquired Von Willebrand Syndrome. This bleeding syndrome has now been shown to result from the loss of the largest multimers of von Willebrand Factor (VWF) and is therefore classified as acquired Type 2A Von Willebrand Syndrome. Hypotheses suggest that the high shear stresses that are obtained in tortuous angiodysplastic lesions work with this deficiency of VWF, to produce gastrointestinal bleeding that is notoriously difficult to elucidate on endoscopy. It has been shown repeatedly that replacement of a stenotic aortic valve results in cessation of bleeding. Here we present a case of Heyde's Syndrome diagnosed with abnormal Closure Times and normal VWF Ristocetin cofactor activity. In this case, a 79-year-old man with known aortic stenosis and several episodes of GI bleeding was cured of a life threatening hemorrhage after the replacement of his stenotic aortic valve. At the time of his first notable gastrointestinal bleed, a tagged RBC scan showed a source of hemorrhage in the small bowel. Subsequently, two video capsule endoscopies showed jejunal angiodysplasia. After recurrent bleeding episodes, this patient presented with a life-threatening GI hemorrhage, which, in the context of aortic stenosis, raised the suspicion for Heyde's Syndrome. At this time, he presented with hematochezia requiring massive transfusions, and admission to the Intensive Care Unit. A tagged RBC scan showed active bleeding in a location that matched previous scans. The following tests were within normal limits: Factor VIII (1.53), VWF Ag (1.26), VWF:Rco activity (1.11), and the ratio of VWF Ag/VWF:Rco (0.88). However, the Dade Behring PFA-100 platelet function analyzer demonstrated that Closure Times with collagen/adenosine (> 300 sec) and with collagen/epinephrine (> 300 sec) were prolonged. In the clinical context consistent with Heyde's Syndrome, the patient's native aortic valve was replaced with a 21mm Carpentier-Edwards Magna Ease Bovine valve. As is classic for this syndrome, the valve replacement was curative. Since the surgery, the patient has not required further transfusions or interventions for gastrointestinal hemorrhage. In this case, our observations are consistent with previous reports by Warkentin et al. and Vincentellli et al. What is unique about our current report is that we measured both Ristocetin cofactor activity and Closure Times, two commonly available assays in most coagulation laboratories. Ristocetin cofactor activity is the current gold standard for measuring platelet function activity but may miss activities under high shear stress. The Closure Time, on the other hand, is able to detect defects in platelet aggregation under such conditions and may be the only manner by which such abnormalities in VWF function are detected. Therefore, we conclude that Closure Times should be used to screen for acquired Von Willebrand's Syndrome in Heyde's Syndrome. Disclosures: No relevant conflicts of interest to declare.

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

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Nelson Musilanga ◽  
Zhou Hongli ◽  
Cai Hongyu
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Elderly Patients ◽  
Gastrointestinal Bleeding ◽  
Deficiency Anemia ◽  
Management Approach ◽  
Acquired Von Willebrand Syndrome ◽  
Clinical Scenarios ◽  
Heyde’S Syndrome ◽  
Von Willebrand

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.

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.

scholarly journals Severe Calcific Aortic Valve Stenosis and Bleeding: Heyde's Syndrome

10.5772/20610 ◽  
2011 ◽  
Author(s):  
Giampaolo Zoffoli ◽  
Domenico Mangino ◽  
Andrea Venturini ◽  
Angiolino Asta ◽  
Alberto Terrini ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Heyde’S Syndrome

Calcific Aortic-Valve Stenosis and Angiodysplasia of the Colon: Heyde's Syndrome-Report of two Cases

1990 ◽  
Vol 38 (06) ◽  
pp. 374-376 ◽  
Author(s):  
E. Apostolakis ◽  
C. Doering ◽  
M. Kantartzis ◽  
J. Winter ◽  
H. Schulte
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Heyde’S Syndrome ◽  
Syndrome Report
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