Heyde's Syndrome: Presentation and Successful Treatment With Transcatheter Aortic Valve Implantation (TAVI)

Heyde's syndrome, characterized by the triad of severe aortic stenosis (AS), GI bleeding (GIB) from angiodysplasia, and acquired von Willebrand syndrome, presents a complex diagnostic and therapeutic challenge. We report the case of a male patient in his 70s with recurrent melena and profound anemia requiring multiple transfusions. Extensive initial investigations, including gastroscopy and colonoscopy, failed to identify a bleeding source. The diagnosis was suspected after echocardiography confirmed critical AS and was later confirmed by capsule endoscopy, which revealed bleeding small bowel angiodysplasia. Instead of pursuing direct endoscopic treatment of the angiodysplasia, the decision was made to address the underlying cause with transcatheter aortic valve implantation (TAVI). Following the procedure, the patient's hemoglobin stabilized, and subsequent enteroscopy confirmed resolution of the angiodysplasia. This case highlights that in patients with AS and obscure GIB, maintaining a high index of suspicion for Heyde's syndrome is crucial. It demonstrates that timely intervention with TAVI can serve as a definitive treatment by resolving the bleeding diathesis through correction of the shear-stress platelet insult and underscores the importance of a multidisciplinary approach between cardiology and gastroenterology to achieve optimal patient outcomes.