Aortic Bioprosthetic Stenosis Leading to Heyde Syndrome

Heyde syndrome (HS) is the constellation of aortic stenosis and gastrointestinal bleeding due to arteriovenous malformation (AVM).

A 74-year old man presented with angina, dyspnea, and fatigue. His work-up was pertinent for significant anemia, severe bioprosthetic aortic stenosis, and a duodenal AVM. The patient required blood transfusions and AVM clipping. He was diagnosed with bioprosthetic HS and referred to the cardiology team for transcatheter aortic valve replacement consideration.

Reports of bioprosthetic HS are scarce in the literature. This case report describes the investigation and management of HS amid recurrent anemic episodes and diagnostic uncertainty.

Recurrent episodes of idiopathic anemia in patients with a prosthetic valve should raise concern for HS. Clinicians with a high suspicion of HS and negative esophagogastroduodenoscopy/colonoscopy should pursue capsule endoscopy or push enteroscopy to fully assess the small bowel. A normal von Willebrand factor in isolation should not rule out HS.