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Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The Heyde syndrome consists of the association of gastrointestinal (GI) bleeding from angiodysplasia in the large or small bowel with aortic valve stenosis. How the vascular lesions arise is unknown, but the bleeding usually resolves after valve replacement. A link with intestinal angiodysplasia and abnormalities of von Willebrand factor (VWF) has been noted. Loss of the highest-molecular-weight multimers of VWF and bleeding also have been described in subaortic stenosis in hypertrophic cardiomyopathy, in isolated mitral and aortic insufficiency, in endocarditis, in patients with prosthetic valve stenosis or regurgitation, and in patients with left ventricular assist devices (LVADs). Cardiac repair or removal of LVAD eliminates VWF dysfunction and is curative of bleeding in the majority.6
Bleeding from the Colon and Rectum
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Charles B. Whitlow, Ben Hopkins
Several associated conditions have been identified in patients with AD. Heyde’s syndrome describes the association of aortic stenosis (AS) with AD. Whether AS is causal for AD seems unclear. However, aortic valve replacement has been associated with decreased bleeding rates.28 Von Willebrand disease and chronic renal failure are also associated with increased bleeding rates from AD.
Valvular heart disease
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
Enquire about childhood infection with rheumatic fever, and what symptoms they experienced. Also ask about rectal blood loss in anaemic patients, as there is an association between aortic stenosis and angiodysplasia (Heyde’s syndrome).
A case of recurrent obscure gastrointestinal bleeding: Heyde’s syndrome – case report and review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Rajarajeshwari Ramachandran, Hakim Uqdah, Niraj Jani
During the index admission, EGD and colonoscopy were performed and again the source of bleeding could not be identified. With the recurrent episodes of obscure gastrointestinal bleeds and the examination findings suggestive of aortic stenosis, Heyde’s syndrome was suspected. An echocardiogram was completed and he was found to have severe aortic stenosis with a valve area of 0.6 square centimeter and mean aortic valve gradient of 37 mmHg. Capsule endoscopy was performed and it revealed multiple arteriovenous malformations in the jejunum (Figure 1), consistent with the diagnosis of Heyde’s syndrome. His von-Willebrand factor antigens and multimeric analysis were within normal limits.
Valvular Resistance and Bleeding Events Among Patients Undergoing Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2019
Masahiko Asami, Thomas Pilgrim, Stefan Stortecky, Fabien Praz, Jonas Lanz, Dik Heg, Eva Roost, Stephan Windecker, Lukas Hunziker
The Heyde syndrome is a triad of AS, acquired von Willebrand’s disease, and bleeding from gastrointestinal arteriovenous malformations.24,25 High fluid shear stress in patients with severe AS renders the multimers more susceptible to cleavage by disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 (ADAMTS13).26 Thus, increased shear stress leads to the mechanical disruption of large von Willebrand factor multimers and induces the consequent bleeding tendency.7,8 It may be hypothesized that the increased shear stress in patients with HVR may at least partially explain the significantly higher bleeding events in our study population. Of note, patients with HVR had an increased risk of both procedural and non-procedural bleeding at short-term follow-up after the intervention than those with LVR. The landmark analysis no longer suggested a difference in bleeding events between HVR and LVR extending beyond 1 day, which may be explained by the reduction in TAVR-induced shear stress. Indeed, in a previous small cohort study, the elimination of stenosis by surgical repair was recommended as a treatment option for bleeding tendency in AS patients.6,11,27 Thus, patients with HVR must be carefully evaluated for bleeding events during the first day after the intervention, and anti-thrombotic regimens may be adjusted in the early phase after TAVR in this setting. Currently, at least three randomized controlled trials with regard to novel anti-thrombotic regimens (NCT02247128, NCT02556203, and NCT 02664649) after TAVR are on-going.28,29 The identification of safer and more effective anti-thrombotic regimens is absolutely demanded for patients with transcatheter heart valve prosthesis.