Unusual Gastrointestinal Bleeding After Sutureless Aortic Valve Replacement: A Word of Caution

Iquille, Jules; Nader, Joseph; Colpart, E.; Caus, Thierry

doi:10.1016/j.athoracsur.2016.08.073

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…We summarized the remaining 34 articles of case reports following aortic valve intervention in patients with Heyde's syndrome, with special references to angiodysplasia and HMW multimers of VWF (Table 1). To the best of our knowledge, there were seven reports that demonstrated persistence or disappearance of angiodysplasia after aortic valve intervention 10,11,16,30,31,35,41) . Importantly, although gastrointestinal bleeding ceased after aortic valve intervention in many case reports, followup endoscopic images to confirm the presence or absence of angiodysplasia and alterations of HMW patients with severe AS 5) .…”

Section: Discussionmentioning

confidence: 99%

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

Tsuchiya

Matsumoto

Doman

et al. 2020

JAT

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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

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Section: Discussionmentioning

confidence: 99%

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

Tsuchiya

Matsumoto

Doman

et al. 2020

JAT

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“…The authors reported no further episodes of gastrointestinal bleeding with normalization of HMW vWF multimer as summarized in Table 2. Although these findings were not replicated in a few case reports [54,55], most of the evidence available in the literature has proven AVR to be more effective.…”

Section: Aortic Valve Replacementmentioning

confidence: 87%

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

2021

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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.

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“…All patients recovered well during the follow-up, except 5 patients who developed various complications. One patient [15] had perivalvular leakage after AVR followed by gastrointestinal bleeding, and the second AVR with biological valve stopped the bleeding. Gastrointestinal bleeding of 2 patients recurred.…”

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confidence: 99%

Aortic Valve Replacement for Patients with Heyde Syndrome: A Literature Review

Lin

Yao

2021

Chinese Medical Sciences Journal

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Objective To explore the characteristics and clinical outcomes of patients with Heyde syndrome (HS) who undergo aortic valve replacement (AVR).Methods Electronic databases PubMed, Embase, Ovid, WANFANG, VIP and CNKI were searched to identify all case reports of HS patients undergoing AVR surgery, using different combinations of search terms "Heyde syndrome", "gastrointestinal bleeding", "aortic stenosis", and "surgery". Three authors independently extracted the clinical data including the patients' characteristics, aortic stenosis severity, gastrointestinal bleeding sites, surgical treatments and prognosis. ResultsFinally, 46 case reports with 55 patients aging from 46 years to 87 years, were determined eligible and included. Of them, 1 patient had mild aortic stenosis, 1 had moderate aortic stenosis, 42 had severe aortic stenosis, and 11 were not mentioned. Gastrointestinal bleeding was detected in colon (n=8), jejunum (n=6), ileum (n=4), cecum (n=3), duodenal (n=3) and multiple sites (n=8). No specific bleeding site was identified in 23 patients. Preoperative hemoglobin ranged from 43 to 117 g/L. The level of high molecule weight (HMW) von Willebrand factor (vWF) examined in 16 patients was decreased in all cases but one. Of the 55 patients, 43 underwent AVR, and 12 received transcatheter AVR. Aortic valves of 14 cases were replaced by mechanical valves, and 33 cases by

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Unusual Gastrointestinal Bleeding After Sutureless Aortic Valve Replacement: A Word of Caution

Cited by 3 publications

References 5 publications

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

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

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

Aortic Valve Replacement for Patients with Heyde Syndrome: A Literature Review

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