Heyde Syndrome-Pathophysiology and Perioperative Implications.

Area of Science:

• Cardiology
• Gastroenterology
• Hematology

Background:

• Heyde syndrome links calcific aortic valve stenosis (AVS) with gastrointestinal (GI) bleeding.
• This condition involves a deficiency in high-molecular-weight von Willebrand factor (Hmw VWF) due to rheologic stress from AVS.
• Angiodysplastic vessels in AVS patients exacerbate bleeding risk when Hmw VWF is compromised.

Purpose of the Study:

• To elucidate the pathophysiologic link between AVS and GI bleeding in Heyde syndrome.
• To highlight the role of von Willebrand factor (VWF) dysfunction in this condition.
• To outline perioperative management strategies for patients with Heyde syndrome.

Main Methods:

• Review of the pathophysiology connecting AVS, VWF proteolysis, and GI bleeding.
• Analysis of the impact of aortic valve replacement on GI bleeding and VWF recovery.
• Discussion of perioperative management including coagulation monitoring and therapeutic approaches.

Main Results:

• Aortic valve replacement (surgical or transcatheter) often definitively treats GI bleeding in Heyde syndrome.
• Valve replacement leads to the recovery of functional high-molecular-weight VWF multimers.
• Understanding VWF dynamics is key to managing GI bleeding in AVS patients.

Conclusions:

• Heyde syndrome pathophysiology involves AVS-induced VWF deficiency, increasing GI bleed risk.
• Aortic valve replacement is a primary treatment, restoring Hmw VWF and resolving bleeding.
• Targeted perioperative management, focusing on VWF status, is crucial for patient outcomes.