Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde's Syndrome: A Case Report and Review of the Literature

Abstract

The official journal of the Japan Atherosclerosis Society and the Asian Pacific Society of Atherosclerosis and Vascular Diseases Case Report An 83-year-old woman with severe aortic stenosis was admitted to our hospital due to heart failure with refractory anemia requiring blood transfusions. She had repetitive bleeding episodes from endoscopically proven angiodysplasia in the stomach. Moreover, she repeatedly underwent endoscopic argon plasma coagulation for hemostasis. Importantly, she had a deficiency of the high-molecular-weight (HMW) multimers of von Willebrand factor (VWF), and she was diagnosed with Heyde's syndrome. After she underwent transcatheter aortic valve implantation (TAVI), aortic valve area and mean left ventricular aorta pressure gradient improved. Notably, endoscopy showed cessation of bleeding at 10 days after TAVI and the disappearance of angiodysplasia at 4 months after TAVI. Even at 2 years after TAVI, follow-up endoscopy showed remaining free of angiodysplasia in the stomach. She experienced no episodes of anemia since TAVI procedure. Additionally, analysis of HMW multimers demonstrated immediate and lasting recovery after TAVI. Recovery of HMW multimers of VWF with cessation of gastrointestinal bleeding following aortic valve replacement has been previously reported in a patient diagnosed with Heyde's syndrome. To the best our knowledge, this is the first case to demonstrate that angiodysplasia disappears after TAVI for a long term with endoscopic images in a patient with Heyde's syndrome. Here, we summarized case reports of patients with Heyde's syndrome that required aortic valve intervention. Cessation of gastrointestinal bleeding and anemia after aortic valve intervention for severe aortic stenosis may be attributed not only to recovery of HMW multimers of VWF but also to the disappearance of angiodysplasia. that is characterized by focal or diffused venous/capillary lesions presenting as bright red ectatic vessels or pulsatile red protrusions, with surrounding venous dilatation or patchy erythema with or without oozing 3, 4) and is known to easily bleed. Heyde's syndrome has been reported to occur in approximately 20% of

Disappearance of Atypical Gastric Mucosal Bleeding due to Heyde’s Syndrome after Transcatheter Aortic Valve Implantation

“…This means that about 33% of patients did not have acquired VWF abnormalities, which was also the case in our patient. There have been several reports of cases of Heyde’s syndrome that did not show loss of HMW multimers of VWF [4, 8].…”

Systemic bevacizumab for refractory bleeding and transfusion-dependent anemia in Heyde syndrome

“…Bleeding in Heyde syndrome can be highly morbid or even fatal, and severe anemia concurrent with severe aortic stenosis can be debilitating. Resolution of angiodysplasia and achievement of durable hemostasis in Heyde syndrome often requires aortic valve intervention, 4 which may present a clinical dilemma because aortic valve intervention requires tolerance of antiplatelet and/or anticoagulant therapy. Angiodysplasias in Heyde syndrome are thought to occur as a result of dysregulated angiogenesis from the loss of high molecular weight von Willebrand factor multimers (secondary to shear forces from the stenotic aortic valve).…”

El síndrome de Heyde

“…El papel de la estenosis aórtica en la génesis de angiodisplasias encuentra apoyo adicional en el estudio ya mencionado de Batur y col. (15) y en reportes con documentación endoscópica de desaparición total de angiodisplasias tras la resolución de la valvulopatía (34,35) .…”