Gastrointestinal Bleeding in Native and Prosthetic Valve Disease

Area of Science:

• Cardiology
• Gastroenterology
• Hematology

Background:

• The association between aortic stenosis and gastrointestinal bleeding, known as Heyde's syndrome, was historically debated.
• Acquired von Willebrand syndrome (AVWS) is now recognized as a key mechanism linking cardiovascular conditions to bleeding.
• The severity of AVWS in left ventricular assist device therapy has solidified understanding of this link.

Purpose of the Study:

• To elucidate the mechanisms of gastrointestinal bleeding in patients with aortic stenosis and other cardiovascular conditions.
• To highlight the role of von Willebrand factor (vWF) multimer loss in correlating with disease severity.
• To propose vWF function tests as biomarkers for cardiovascular dysfunction.

Main Methods:

• Review of historical and current literature on aortic stenosis and gastrointestinal bleeding.
• Analysis of the pathophysiology of turbulence-related proteolysis of vWF multimers.
• Discussion of diagnostic and therapeutic implications, including biomarkers and treatment outcomes.

Main Results:

• Gastrointestinal bleeding from intestinal angiodysplasia occurs in aortic stenosis due to proteolysis of high molecular weight vWF multimers.
• This phenomenon is also observed in other conditions like hypertrophic cardiomyopathy, mitral/aortic insufficiency, endocarditis, and prosthetic valve dysfunction.
• Loss of high molecular weight vWF multimers directly correlates with the severity of the cardiovascular lesion.

Conclusions:

• Gastrointestinal bleeding in valvular heart disease is primarily driven by acquired von Willebrand syndrome.
• Testing vWF function can serve as a biomarker for cardiovascular lesion severity, including paravalvular leak.
• While endoscopic or surgical interventions offer temporary relief, cardiac repair is curative for the underlying bleeding disorder.