Aortic Stenosis Complicated by Gastrointestinal Arteriovenous Malformations: It is not Always Heyde Syndrome

Thakker, Ravi; Suthar, Krishna; Kline, Kevin; Chatila, Khaled; Hanayneh, Muhannad Al

doi:10.7759/cureus.8876

Cited by 1 publication

(2 citation statements)

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“…Although we did not evaluate VWF multimers and changes in gastrointestinal angiodysplasia after TAVI, we are preparing a prospective study to examine these subjects. Although previous studies showed that gastrointestinal angiodysplasia in patients with severe AS disappeared after aortic valve replacement and TAVI [15][16][17][18][19]21], 6 patients had hemorrhages after TAVI, from 15 days to 377 days after treatment of severe AS in our study. The resolution of high shear stress at the site of the stenotic aortic valve could improve anemia and lead to the reduction or disappearance of angiodysplasia through these mechanisms.…”

Section: Discussioncontrasting

confidence: 78%

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Gastrointestinal Angiodysplasia in Patients with Severe Aortic Stenosis: The Endoscopic Features of Heyde’s Syndrome

Sugino,

Inoue,

Zen

et al. 2023

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Introduction: Aortic stenosis (AS) is sometimes associated with gastrointestinal bleeding, and this phenomenon is known as Heyde’s syndrome. Such bleeding is most often considered to originate from gastrointestinal angiodysplasias, but the frequency and endoscopic features of such bleeding remain unclear. This study aimed to determine the frequency and endoscopic features of gastrointestinal angiodysplasia in patients with severe AS. Patients and Methods: In this multicenter, retrospective study, we evaluated consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with severe AS from May 2016 to December 2019. We extracted the data on the clinicopathological features according to the status of anemia, the proportion of patients who underwent gastrointestinal endoscopic examinations and demonstrated gastrointestinal angiodysplasia, and identified the endoscopic features associated with such patients. Results: In 325 patients, the rates of moderate/severe anemia (hemoglobin < 11 g/dL) were 52%. Regarding medicine, there were no significant differences between the patients with and without moderate/severe anemia. Patients were examined by esophagogastroduodenoscopy (21%), colonoscopy (12%), and balloon-assisted enteroscopy or small bowel capsule endoscopy (1.5%). Patients with moderate/severe anemia had significantly more angiodysplasia (38.3% vs. 7.7%; p < 0.0001) and active bleeding (23.4% vs. 0%; p < 0.01). Angiodysplasia was detected in 21 patients (stomach, n = 9; small intestine, n = 5, and colon, n = 10). Conclusions: The results suggest, for the first time, that patients with severe AS who underwent TAVI and moderate/severe anemia frequently had gastrointestinal angiodysplasia and active bleeding throughout the entire gastrointestinal tract.

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Section: Discussioncontrasting

confidence: 78%

“…Previous case reports showed that patients with severe AS had angiodysplasia of the stomach, small intestine, and colon [ 15 – 19 ]. As expected, our study showed that 21 of 73 patients with severe AS who underwent endoscopic examinations and TAVI had angiodysplasia located in the stomach, small intestine, or colon.…”

Section: Discussionmentioning

confidence: 99%