Gastrointestinal bleeding and aortic stenosis: three cases of heyde syndrome

Heyde syndrome is a rare clinical entity, characterized by the combination of gastrointestinal bleeding due to angiodysplasia and calcified aortic stenosis.The most likely pathophysiological mechanism is acquired von Willebrand syndrome type 2.While valve replacement generally halts the bleeding,in some cases, bleeding persists. We present 3 cases of Heyde syndrome to enrich the literature and raise awareness among healthcare providers for optimal management.

The three patients, with an average age of 70 years (two men and one woman), all had severe aortic stenosis, with a mean valve area of 0.6 cm² and a transvalvular pressure gradient of 65 mmHg. Additionally,all had arterial hypertension,two had atrial fibrillation,and one had coronary insufficiency. They presented with recurrent rectal bleeding and episodes of severe iron deficiency anemia, requiring multiple transfusions.Endoscopic examinations revealed angiodysplastic lesions in two men, located in the cecum and ascending colon.The female patient had a negative result but was diagnosed with jejunal angiodysplasia through capsule endoscopy. Despite several sessions of argon plasma coagulation, bleeding persisted. The high-molecular-weight multimers of von Willebrand factor were reduced in two patients. Based on these findings, the diagnosis of Heyde syndrome was made,and all three patients underwent aortic valve replacement. After one year of follow-up,no recurrence of bleeding was noted in two patients, with stable hemoglobin levels, but one patient continued to experience persistent bleeding.In conclusion,Heyde syndrome should be considered in patients with aortic stenosis and angiodysplasia. While valve replacement may alleviate bleeding,it can persist in some cases, underscoring the need for further research to enhance diagnosis and treatment.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025