Gastrointestinal Bleeding and Aortic Stenosis (Heyde Syndrome): The Role of Aortic Valve Replacement

Severe aortic stenosis is associated with significant morbidity and mortality if untreated. The transcatheter aortic valve implantation(TAVI) is now feasable and effective gold standart treatment option in patients with severe aortic valve stenosis(AS) and associated with similar rate of major adverse events compared to the surgery. The relation between aortic stenosis and gastrointestinal angiodysplasia was known as Heyde’s Syndrome since 1958. High fluid shear stress through the narrowed valve is thought to be the underlying mechanism leads to the mechanical disruption of the large von Willebrand factor multimers. Aortic valve replacement either surgical or with TAVI seems to reduce gastrointestinal bleeding in approximately 80% in patients with Heyde syndrome in whom gastrointestinal bleeding is associated with intestinal angiodysplasia due to acquired von Willebrand’s disease (type 2A) and aortic valve stenosis. The patients especially with atrial fibrillation who need anticoagulant therapy may have bleeding risk despite aortic valve replacement. We report a case of patient presenting with a massive intestinal bleeding originating from intestinal angiodysplasia after percutaneous aortic valve replacement.

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The role of transcatheter aortic valve replacement in the patients with severe aortic stenosis requiring major non-cardiac surgery

Cardiovascular Intervention and Therapeutics ◽

10.1007/s12928-019-00575-z ◽

2019 ◽

Vol 34 (4) ◽

pp. 345-351 ◽

Cited By ~ 3

Author(s):

Taishi Okuno ◽

Kazuyuki Yahagi ◽

Yu Horiuchi ◽

Yu Sato ◽

Tetsu Tanaka ◽

...

Keyword(s):

Cardiac Surgery ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve

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Predictive value of left ventricular diastolic chamber stiffness in patients with severe aortic stenosis undergoing aortic valve replacement

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez292 ◽

2019 ◽

Vol 21 (10) ◽

pp. 1160-1168

Author(s):

Vidhu Anand ◽

Rosalyn O Adigun ◽

Jeremy T Thaden ◽

Sorin V Pislaru ◽

Patricia A Pellikka ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Diastolic Pressure ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

The Impact

Abstract Aims Despite improvements in cardiac haemodynamics and symptoms, long-term mortality remains increased in some patients after aortic valve replacement (AVR). Limited data exist on the prognostic role of left ventricular (LV) chamber stiffening in these patients. Methods and results We performed a retrospective analysis in 1893 patients with severe aortic stenosis (AS) referred for AVR. LV end-diastolic pressure–volume relations (EDPVR, P = αV^β) were reconstructed from echocardiographic measurements of end-diastolic volumes and estimates of end-diastolic pressure (EDP). The impact of EDPVR-derived LV chamber stiffness (CS30, at 30 mmHg EDP) on all-cause mortality after AVR was evaluated. Mean age was 76 ± 10 years, 39% were females, and ejection fraction (EF) was 61 ± 12%. The mean LV chamber stiffness (CS30) was 2.2 ± 1.3 mmHg/mL. A total of 877 (46%) patients had high LV stiffness (CS30 >2 mmHg/mL). In these patients, the EDPVR curves were steeper and shifted leftwards, indicating higher stiffness at all pressure levels. These patients were slightly older, more often female, and had more prevalent comorbidities compared to patients with low stiffness. At follow-up [median 4.2 (interquartile range 2.8–6.3) years; 675 deaths], a higher CS30 was associated with lower survival (hazard ratio: 2.7 for severe vs. mild LV stiffening; P < 0.0001), both in patients with normal or reduced EF. At multivariate analysis, CS30 remained an independent predictor, even after adjusting for age, sex, comorbidities, EF, LV remodelling, and diastolic dysfunction. Conclusion Higher preoperative LV chamber stiffening in patients with severe AS is associated with poorer outcome despite successful AVR.

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ROLE OF CHYLAMYDIAE PNEUMONIA AND CYTOMEGALOVIRUS IN PATIENTS WITH AORTIC STENOSIS UNDERGOING AORTIC VALVE REPLACEMENT

Atherosclerosis Supplements ◽

10.1016/s1567-5688(08)70847-x ◽

2008 ◽

Vol 9 (1) ◽

pp. 212

Author(s):

A. Yildirir ◽

H. Bozbas ◽

O. Demir ◽

A. Sezgin ◽

B. Gultekin ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement

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Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis

Circulation ◽

10.1161/circulationaha.120.048048 ◽

2021 ◽

Vol 143 (10) ◽

pp. 1043-1061

Author(s):

Flavien Vincent ◽

Julien Ternacle ◽

Tom Denimal ◽

Mylène Shen ◽

Bjorn Redfors ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Controlled Trials ◽

Randomized Controlled ◽

Transcatheter Aortic Valve ◽

Risk Patients

After 15 years of successive randomized, controlled trials, indications for transcatheter aortic valve replacement (TAVR) are rapidly expanding. In the coming years, this procedure could become the first line treatment for patients with a symptomatic severe aortic stenosis and a tricuspid aortic valve anatomy. However, randomized, controlled trials have excluded bicuspid aortic valve (BAV), which is the most frequent congenital heart disease occurring in 1% to 2% of the total population and representing at least 25% of patients 80 years of age or older referred for aortic valve replacement. The use of a less invasive transcatheter therapy in this elderly population became rapidly attractive, and approximately 10% of patients currently undergoing TAVR have a BAV. The U.S. Food and Drug Administration and the “European Conformity” have approved TAVR for low-risk patients regardless of the aortic valve anatomy whereas international guidelines recommend surgical replacement in BAV populations. Given this progressive expansion of TAVR toward younger and lower-risk patients, heart teams are encountering BAV patients more frequently, while the ability of this therapy to treat such a challenging anatomy remains uncertain. This review will address the singularity of BAV anatomy and associated technical challenges for the TAVR procedure. We will examine and summarize available clinical evidence and highlight critical knowledge gaps regarding TAVR utilization in BAV patients. We will provide a comprehensive overview of the role of computed tomography scans in the diagnosis, and classification of BAV and TAVR procedure planning. Overall, we will offer an integrated framework for understanding the current role of TAVR in the treatment of bicuspid aortic stenosis and for guiding physicians in clinical decision-making.

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