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Successful endoscopic clipping for bleeding from colonic angiodysplasia in a case of Heyde syndrome
Nobuyuki Takahashi1, Kazuaki Tanabe, Hiroyuki Yoshitomi
14th Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo City, Shimane, Japan. yukihiro@med.shimane-u.ac.jp
Insights
Degenerative aortic valve disease, like stenosis, is common in older adults. This case highlights Heyde syndrome, linking aortic stenosis, acquired von Willebrand disease, and gastrointestinal bleeding from angiodysplasia.
Area of Science:
- Cardiology
- Gastroenterology
- Hematology
Background:
- Degenerative aortic valve diseases, including sclerosis, calcification, and stenosis, are prevalent in the aging population.
- Increased life expectancy contributes to a rising number of elderly patients with these conditions.
Observation:
- A case study involving an 82-year-old woman with severe aortic stenosis and unexplained anemia due to colonic angiodysplasia is presented.
- Endoscopic clipping successfully treated the colonic angiodysplasia before aortic valve replacement.
- Immunoblot analysis revealed a decrease in large molecular weight multimers of von Willebrand factor.
Findings:
- The patient's anemia was attributed to gastrointestinal bleeding from colonic angiodysplasia.
- Successful management of both colonic angiodysplasia and aortic valve stenosis was achieved.
- A decrease in von Willebrand factor multimers was noted, consistent with acquired von Willebrand disease.
Implications:
- This case illustrates Heyde syndrome, a known association between aortic valve stenosis, acquired von Willebrand disease, and gastrointestinal bleeding in the elderly.
- Clinicians should consider acquired von Willebrand disease and angiodysplastic gastrointestinal bleeding in elderly patients presenting with aortic valve stenosis.
- Early diagnosis and management of these interconnected conditions are crucial for patient outcomes.
Background:
Aortic valve sclerosis, calcification, and stenosis are common in the elderly. Increased life expectancy has resulted in a growing population of elderly people, with a corresponding increase in the number of patients with these degenerative aortic valve diseases.
Case Report:
We report a case of severe aortic stenosis in an 82-year-old woman with bleeding due to colonic angiodysplasia. The patient presented with anemia unexpectedly before her aortic valve replacement. Colon fiberscopy revealed that colonic angiodysplasia was responsible for the bleeding. The lesion was treated with endoscopic clipping before the successful aortic valve replacement. Additionally, her immunoblot analysis detected a decrease of large molecular weight multimers of von Willebrand factor.
Conclusions:
The relationship between aortic valve stenosis, acquired von Willebrand disease and gastrointestinal bleeding in elderly patients is known as Heyde syndrome. Clinicians should be aware of the possibilities of acquired von Willebrand disease and gastrointestinal bleeding from angiodysplasia in patients with aortic valve stenosis.
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