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• W2979175526 abstract "The association between aortic stenosis (AS) and gastrointestinal (GI) bleeding was initially recognized in 1958, since which time it has been studied extensively. Heyde's syndrome, which features intestinal angioectasia as the source of bleeding, is due to an acquired form of von Willebrand disease (vWF), in which there is a deficiency of large multimers of vWF as the result of unregulated cleavage in the setting of increased shear stress across a stenotic aortic valve. The subsequent decline in hemostatic competence is thought to lead to the development of angioectasia. There is growing evidence that aortic valve replacement (AVR) reverses the deficiency and affects significant improvement in the morbidity associated with GI bleeding. However, there has been a paucity of data regarding GI bleeding outcomes following aortic valvuloplasty. An 89-year-old female had been followed in the GI clinic for two years for obscure GI bleeding. She had a history significant for critical AS, atrial fibrillation and congestive heart failure. She also had recurrent hospitalizations for melena and developed transfusion-dependent anemia, for which she required weekly blood transfusions. She was followed closely in the GI clinic and underwent 12 endoscopic studies/interventions in a span of 19 months, all of which demonstrated small bowel angioectasias, intermittently treated with argon plasma coagulation. She was concurrently followed in Cardiology clinic, where her critical AS was followed closely. Because of age and comorbidities, she was not a viable candidate for AVR. However, given her continued transfusion-dependent anemia secondary to Heyde's Syndrome, she was evaluated for and underwent aortic valvuloplasty, which resulted in a reduction in her mean transvalvular gradient from 59mm Hg to 26mm Hg. Thereafter, she experienced profound reduction in melena, transfusion requirements and has yet to require further hospitalization for GI bleeding or endoscopy. While AVR has become an increasingly attractive option for patients who suffer from severe GI bleeding as the result of Heyde's syndrome, not all patients are candidates for this treatment. We present the case of a patient who had critical AS and severe, recurrent angioectatic GI bleeding with transfusion-dependent anemia who underwent balloon aortic valvuloplasty and had marked improvement in bleeding morbidity. Valvuloplasty should be considered as a feasible strategy for those with Heyde's syndrome who are not eligible for valve replacement, or as a bridge to transcatheter AVR." @default.
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• W2979175526 date "2015-10-01" @default.
• W2979175526 modified "2023-10-02" @default.
• W2979175526 title "Aortic Valvuloplasty in Heydeʼs Syndrome: Bridging the Gap to Improve Bleeding Outcomes" @default.
• W2979175526 doi "https://doi.org/10.14309/00000434-201510001-01094" @default.
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