Das Heyde-Syndrom - eine kritische Bestandsaufnahme

Zusammenfassung

Die Assoziation von Aortenstenose und gastrointestinalen Angiodysplasien bzw. okkulten gastrointestinalen Blutungen wird als „Heyde-Syndrom” bezeichnet. Ein epidemiologischer und kausal begründeter Zusammenhang beider Erkrankungen ist bis heute umstritten. In der vorliegenden Arbeit wird der aktuelle Kenntnisstand über das Heyde-Syndrom vermittelt. Hierbei wird auf Epidemiologie, Pathogenese und klinische Implikationen eingegangen.

Summary

The co-existence of aortic-valve stenosis and gastrointestinal angiodysplasia or occult gastrointestinal bleeding is called Heyde's syndrome. There is, however, still controversy about its epidemiology and pathogenesis. Current knowledge of Heyde's sSyndrome is reviewed here, with special regard of its epidemiology, pathogenesis and clinical features.

Schlüsselwörter

Heyde-Syndrom - Aortenstenose - gastrointestinale Blutung - Pathogenese

Key words

Heyde’s syndrome - aortic-valve stenosis - gastrointestinal bleeding - pathogenesis - therapy

Literatur

• 1 Anderson R P, Mc Grath K, Street A. Reversal of aortic stenosis, bleeding gastrointestinal angiodysplasia, and von Willebrand syndrome by aortic valve replacement.  Lancet. 1996;  347 690
• 2 Baciewicz F A, Davis J T. Heyde’s syndrome: failure of a mechanical prosthesis and the possibility of a coagulation defect.  Ann Thorac Surg. 1987;  44 554-555
• 3 Batur P, Stewart W J, Isaacson J H. Increased prevalence of aortic stenosis in patients with arteriovenous malformations of the gastrointestinal tract in Heyde syndrome.  Arch Intern Med. 2003;  163 1821-1824
• 4 Bhutani M S, Gupta S C, Markert R J, Barde C J, Donese R, Gopalswamy N. A prospective controlled evaluation of endoscopic detection of angiodysplasia and its association with aortic valve disease.  Gastrointest Endosc. 1995;  42 398-402
• 5 Boley S J, Sammartano R, Adams A. et al . On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging.  Gastroenterology. 1977;  72 650
• 6 Boyle J M, Rowen H E, Saito H, Vicic W J, Ankeney J L. Severe aortic stenosis in a patient with recurrent gastrointestinal bleeding: replacement of the aortic valve with a porcine xenograft.  Am J Gastroenterol. 1981;  75 135-139
• 7 Cappell M S, Lebwohl O. Cessation of recurrent bleeding from gastrointestinal angiodysplasias after aortic valve replacement.  Ann Intern Med. 1986;  105 54-57
• 8 Cody M C, O’Donnovan P B, Hughes R W. Idiopathic gastrointestinal bleeding and aortic stenosis.  Am J Dig Dis. 1974;  19 393-398
• 9 Foutch P G. Angiodysplasia of the gastrointestinal tract.  Am J Gastroenterol. 1993;  88 807
• 10 Froom P, Margulis T, Grenadier E, Palant A, David M, Aghai E. Von Willebrand factor and mitral valve prolapse.  Thromb Haemost. 1988;  60 230-231
• 11 Galloway S J, Caserella W J, Shimkin P M. Vascular malformations of thr right colon as a cause of bleeding in patients with aortic stenosis.  Radiology. 1974;  113 11-15
• 12 Gill J C, Wilson A D, Endres-Brooks J, Montgomery R R. Loss of the largest von Willebrand factor multimers from the plasma of patients with congenital cardiac defects.  Blood. 1988;  67 758-761
• 13 Gupta N, Longo W E, Vernava A M. Angiodysplasia of the lower gastrointestinal tract: An entity readily diagnosed by colonoscopy and primarily managed nonoperatively.  Dis Colon Rectum. 1995;  38 979
• 14 Heyde E C. Gastrointestinal bleeding in aortic stenosis.  N Engl J Med. 1958;  259 196
• 15 Imperiale T F, Ransohoff D F. Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? A methodologic critique of the literature.  Gastroenterology. 1988;  95 1670-1676
• 16 Junquera F, Saperas E, de Torres I. et al . Increased expression of angiogenic factors in human colonic angiodysplasia.  Am J Gastroenterol. 1999;  94 1070
• 17 King R M, Pluth J R, Giuliani E R. The association of unexplained gastrointestinal bleeding with calcific aortic stenosis.  Ann Thorac Surg. 1987;  44 514-516
• 18 Larsen N H. Heyde syndrome.  Ugeskr Laeger. 1997;  159 4628-4630
• 19 Lindroos M, Kupari M, Heikkila J, Tilvis R. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample.  J Am Coll Cardiol. 1993;  21 1220-1225
• 20 Love J W. The syndrome of calcific aortic stenosis and gastrointestinal bleeding: resolution following aortic valve replacement.  J Thorac Cardiovasc Surg. 1982;  83 779-783
• 21 Mannucci R. Current therapy of von Willebrand’disease.  Haemostasis. 1994;  24 264-324
• 22 Marcus R H, Kinsley R H. Aortic stenosis and unexplained gastrointestinal haemorrhage. Case reports.  S Afr Med J. 1982;  61 559-561
• 23 Mc Namara J J, Austen W G. Gastrointestinal bleeding occuring in patients with acquired valvular heart disease.  Arch Surg. 1968;  97 538-540
• 24 Meyer C T, Troncale F J, Galloway S, Sheahan D G. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature.  Medicine (Baltimore). 1981;  60 36
• 25 Montgomery R R. Structure and function of von Willebrand factor. Philadelphia: Lippincott Williams & Wilkins In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN, eds. Hemostasis and thrombosis 2001: 249-274
• 26 Noach L A, Mathus-Vliegen E M, Dunning A J, Tytgat G N. Angiodysplasias in the digestive tract and associated cardiovascular diseases.  Ned Tijdschr Geneeskd. 1989;  133 1696-1700
• 27 O’Brien J R, Etherington M D, Brant J, Watkins J. Decreased platelet function in aortic valve stenosis: High shear platelet activation then inactivation.  Br Heart J. 1995;  74 641
• 28 O’Brien J R, Tsai H M, Etherington M D. Defective von Willebrand factor activity detected by the filterometer in three clinical conditions.  Platelets. 2000;  11 388-394
• 29 Oneglia C, Sabatini T, Rusconi C. et al . Prevalence of aortic valve stenosis in patients affected by gastrointestinal angiodysplasia.  Eur J Med. 1993;  2 75-78
• 30 Olsson M, Hultcrantz R, Schulman S, Wallgren E. Acquired platelet dysfunction may be an aetiologic factor in Heyde’s syndrome - normalization of bleeding time after aortic valve replacement.  J Intern Med. 2002;  252 516-523
• 31 Pareti F I, Lattuada A, Bressi C. et al . Proteolysis of von Willebrand factor and shear stress-induced platelet aggregation in patients with aortic valve stenosis.  Circulation. 2000;  102 1290-1298
• 32 Pate G E, Mulligan A. An epidemiological study of Heyde’s syndrome: an association between aortic stenosis and gastrointestinal bleeding.  J Heart Valve Dis. 2004;  13 713
• 33 Preik M, Strauer B E. Rezidivierende Epistaxis bei Aortenklappenstenose: eine Variante des Heyde-Syndroms.  Med Klin. 2002;  97 170-173
• 34 Richter J M, Hedberg S E, Athanasoulis C A, Schapiro R H. Angiodysplasia: Clinical presentation and colonoscopic diagnosis.  Dig Dis Sci. 1984;  29 481
• 35 Rogers B H. Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular, and pulmonary disease.  Gastrointest Endosc. 1980;  26 134-138
• 36 Scheffer S M, Leatherman L L. Resolution of Heyde’s syndrome of aortic stenosis and gastrointestinal bleeding after aortic valve replacement.  Ann Thorac Surg. 1986;  42 477-480
• 37 Schmit A, Gay F, Adler M. et al . Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias.  Dig Dis Sci. 1996;  41 2348
• 38 Shindler D M. Aortic stenosis and gastrointestinal bleeding (letter).  Arch Intern Med. 2004;  164 103
• 39 Stewart B F, Siscovick D, Lind B K. et al . Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study.  J Am Coll Cardiol. 1997;  29 630-634
• 40 Sucker C, Feindt P, Scharf R E. Aortic stenosis, von Willebrand factor, and bleeding.  N Engl J Med. 2003;  349 1773-1774
• 41 Sucker C, Feindt P, Zotz R B, Scharf R E. No evidence for increased intraoperative bleeding in aortic-valve stenosis: a comparative analysis of hemotherapy in 136 patients undergoing aortic-valve replacement.  Transfus Med Hemother. 2004 ;  (suppl 3) ) 31 509
• 42 Sucker C, Feindt P, Zotz R B, Stockschlaeder M, Scharf R E. Functional von Willebrand factor assays are not predictive for the absence of highest-molecular weight von Willebrand factor multimers in patients with aortic-valve stenosis.  Thromb Haemostasis. 2005;  94 465-466
• 43 Uniskiewicz B, Kuczewska-Stanecka K. Coexistence of von Willebrand’s disease with mitral valve prolapse.  Pol Tyg Lek. 1992;  47 927-929
• 44 Veyradier A, Balian A, Wolf M. et al . Abnormal von Willebrand factor in bleeding angiodysplasia of the digestive tract.  Gastroenterology. 2001;  120 346-353
• 45 Warkentin T E, Moore J C, Morgan D G. Aortic stenosis and bleeding gastrointestinal angiodysplasia: is acquired von Willebrand syndrome the link?.  Lancet. 1992;  240 35-37
• 46 Warkentin T E, Moore J C, Anand S S. et al . Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome.  Transfus Med Rev. 2003;  17 272
• 47 Weaver G A, Alpern H, Davis J, Ramsey W, Reichelderfer M. Gastrointestinal angiodysplasia associated with aortic valve disease: part of a spectrum of angiodysplasia of the gut.  Gastroenterology. 1979;  77 1-11
• 48 Weaver G A, Arquin P L, Davis J S, Ramsey W H. More on aortic stenosis and gastrointestinal bleeding (letter).  N Engl J Med. 1980;  303 584
• 49 Williams R C. Aortic stenosis and unexplained gastrointestinal bleeding.  Ann Intern Med. 1961;  108 859-863