scholarly journals Did the Angiodysplasia Associated With Heyde's Syndrome Disappear Spontaneously?: A Case Report

2021 ◽  
Author(s):  
Rui Li ◽  
Jiechun Zhang ◽  
Jiaxi Shi ◽  
Lijin Qing ◽  
Wei Wu
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Clinical Manifestations ◽  
Stable Condition ◽  
Exploratory Laparotomy ◽  
Severe Bleeding ◽  
Exertional Dyspnea ◽  
Transcatheter Aortic Valve ◽  
Heyde’S Syndrome

Abstract Background: Multidisciplinary clinical manifestations of Heyde's syndrome and finite accuracy of corresponding examinations toward Heyde's triad make it easily omitted or misjudged in practice. Moreover, aortic valve replacement is often delayed because of the contradiction between anticoagulation and hemostasis. Herein, we present a rare case of atypical Heyde's syndrome whose confirmed intermittent bleeding angiodysplasia was not observed via mesenteric arteriography again, but severe bleeding was dramatically improved by transcatheter aortic valve implantation(TAVI) following laparotomy.Case presentation: A 64-year-old female experienced refractory gastrointestinal bleeding and deteriorating exertional dyspnea with a history of hypertension. Exploratory laparotomy was performed because the hemorrhage persisted and repeated transfusions. The subsequent histological examination revealed angiodysplasia. Heyde's syndrome was not suspected until she bled again combined with aortic valve stenosis detected by echocardiography 3 years later. TAVI was consequently performed in a stable condition with the invisibility of angiodysplasia. The post-procedure and follow-up were uneventful.Conclusions: The visible figures of angiodysplasia or shortage of HMWM-vWFs should not be indispensable for the clinical diagnosis of Heyde's syndrome. Laparotomy could be a bridging therapy to aortic valve replacement for severe hemorrhagic patients, and TAVI may benefit high-risk patients with a stable condition.

scholarly journals Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1331
Author(s):  
Alexander Lind ◽  
Majid Ahsan ◽  
Elif Kaya ◽  
Reza Wakili ◽  
Tienush Rassaf ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Pacemaker Implantation ◽  
Anticoagulation Therapy ◽  
High Rate ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Transcatheter Aortic Valve

Background and Objectives: Permanent pacemaker implantation (PPI) is frequently required following transcatheter aortic valve replacement (TAVR). Dual antiplatelet therapy (DAPT) or oral anticoagulation therapy (OAK) is often necessary in these patients since they are at higher risk of thromboembolic events due to TAVR implantation, high incidence of coronary artery diseases (CAD) with the necessity of coronary intervention, and high rate of atrial fibrillation with the need of stroke prevention. We sought to evaluate the safety, efficiency, and clinical outcomes of early PPI following TAVR using the PlasmaBlade™ (Medtronic Inc., Minneapolis, MN, USA) pulsed electron avalanche knife (PEAK) for bleeding control in patients under DAPT or OAK. Materials and Methods: This retrospective single-center study included patients who underwent PPI after transfemoral TAVR (TF) at our center between December 2015 and May 2020. All PPI were performed using the PlasmaBlade™ Device. Results: The overall PPI rate was 14.1% (83 of 587 patients; 82.5 ± 4.6 years; 45.8% male). The PPI procedures were used to treat high-grade atrioventricular block (81.9%), severe sinus node dysfunction (13.3%), and alternating bundle branch block (4.8%). At the time of the procedure, 35 (42.2%) patients received DAPT, and 48 (57.8%) patients received OAK (50% with vitamin K antagonist (VKA) and 50% with novel oral anticoagulants (NOAK)). One device-pocket hematoma treated conservatively occurred in a patient (1.2%) receiving NOAK. Two re-operations were necessary in patients due to immediate lead dislocation (2.4%). Conclusions: The results of this study illustrate that the use of PlasmaBlade™ for PPI in patients after a TAVR who require antithrombotic treatment is feasible and might result into lower rates of severe bleeding complications compared to rates reported in the literature. Use of the PlasmaBlade device may be considered in this specific group of patients because of their high risk of bleeding.

scholarly journals TCT-702 Impact of Transcatheter Aortic Valve Replacement on Anemia: New Approach to Heyde’s Syndrome

2019 ◽  
Vol 74 (13) ◽  
pp. B689
Author(s):  
Javier Lopez-Pais ◽  
Diego Lopez Otero ◽  
Pablo Antunez Muinos ◽  
Barbara Izquierdo Coronel ◽  
Marta Perez Poza ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
New Approach ◽  
Transcatheter Aortic Valve ◽  
Heyde’S Syndrome

scholarly journals Systemic Bevacizumab for Refractory Bleeding and Transfusion-Dependent Anemia in Heyde Syndrome

2021 ◽  
Author(s):  
Andrew B Song ◽  
Rahul Sakhuja ◽  
Nancy M Gracin ◽  
Ronald Weinger ◽  
Raj S Kasthuri ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Antiangiogenic Therapy ◽  
Severe Bleeding ◽  
Vascular Endothelial ◽  
The Novel ◽  
Transcatheter Aortic Valve ◽  
Red Cell Transfusion ◽  
Endothelial Growth Factor

Heyde syndrome, the co-occurrence of aortic stenosis and bleeding gastrointestinal angiodysplasia, is managed with aortic valve replacement. However, severe bleeding and anemia can preclude safe use of the antiplatelet or anticoagulant therapy required for this intervention. We present a case of the novel and successful treatment of severe, refractory bleeding and transfusion-dependence with antiangiogenic therapy in a patient with Heyde syndrome. Following initiation of systemic bevacizumab, the patient achieved durable hemostasis with normalization of hemoglobin, liberation from red cell transfusion and iron infusion dependence, and successful initiation of aspirin therapy where it had previously failed. This facilitated her subsequent successful transcatheter aortic valve replacement. Plasma vascular endothelial growth factor levels, which were monitored during therapy, rose paradoxically after initiation of bevacizumab and normalized after its discontinuation. Given the angiogenic dysregulation of Heyde syndrome, systemic bevacizumab may be an effective and safe targeted therapy for management of refractory gastrointestinal bleeding, thereby facilitating antiplatelet therapy and aortic valve replacement in these challenging cases. Additional investigation into the therapeutic role of angiogenesis inhibition as a hemostatic modality in Heyde syndrome is warranted.

scholarly journals 808 Frequency and impact of atherothrombotic status in patients undergoing transcatheter aortic valve replacement

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Fabiola Boccuto ◽  
Sabato Sorrentino ◽  
Nicole Carabetta ◽  
Antonio Bellantoni ◽  
Salvatore Giordano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Adverse Events ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Bypass Graft ◽  
Severe Bleeding ◽  
Transcatheter Aortic Valve ◽  
Baseline Characteristics

Abstract Aims Many efforts have been made in the last decade to minimize the risk of bleeding in patients undergoing transcatheter aortic valve replacement (TAVR), such as a less intensive antithrombotic therapy and technical improvement in devices implantation. Conversely, evidence on high atherothrombotic status (HATR) is still lacking in patients undergoing TAVR. Accordingly, in this analysis, we aimed to evaluate frequency and impact of atherothrombotic status in patients undergoing transcatheter aortic valve replacement. Methods Patients who underwent TAVR at our Institution from September 2008 to November 2020 were included in this analysis. Out of 407 patients, 6 (1.5%) were excluded as they underwent only balloon angioplasty or for procedural unsuccess. HATR status includes patients with prior percutaneous coronary intervention/coronary artery bypass graft, prior stroke/transient ischaemic attack (TIA), or with a diagnosis of diabetes. Continuous variables following normal distribution were compared with the student’s t-test and categorical data were analysed with the chi-square test. A Cox regression model was used to evaluate the association between HART status and all-cause mortality at one 1-year follow-up. Results Compared to patients with low atherothrombotic status (LATR) (n = 238; 59.4%), HART patients (n = 163; 40.6%) were older, more likely female and with a higher prevalence of common cardiovascular risk factors including chronic kidney disease, smoke, and hyperlipidaemia. Between LATR and HATR groups, no differences have been observed, in terms of procedural time, type of devices used (Balloon vs. self-expandable device), or hospitalization length. Compared to LART, HART patients were more likely to be discharged on statin (63.7% vs. 83%, P < 000.1), on dual antiplatelet therapy (50.4% vs.58.9%, P = 0.03), or on oral anticoagulant if required (27.7% vs. 29.5%, P = 0.03). Furthermore, no differences have been observed in terms of in-hospital adverse events, including death, severe bleeding, any conduction disturbances requiring pacemaker implantation, access complications, myocardial infarction, or stroke/TIA. For instance, HART was not a predictor of mortality at 1 year follow-up, even after adjustment for baseline characteristics. Conclusion In our population, no differences in procedural and in-hospital adverse events have been observed according to the atherothrombotic profile. HATR patients were more likely to be discharged with more intensive antithrombotic and hypolipidaemic strategies, despite the coexistent high prevalence of bleeding determinants. However, ATR status does not impact 1-year mortality even after adjustment for baseline characteristics.

scholarly journals Acquired Aorto-Right Ventricular Fistula following Transcatheter Aortic Valve Replacement

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Muhammad Tariq Shakoor ◽  
Ashequl M. Islam ◽  
Samia Ayub
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Standard Of Care ◽  
Exertional Dyspnea ◽  
Transcatheter Aortic Valve ◽  
Procedural Complication ◽  
Procedural Complications

Transcatheter aortic valve replacement (TAVR) techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD) formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient.

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