Heyde Syndrome in Moderate Bioprosthetic Aortic Valve Stenosis: A Twist in the Valve

Heyde syndrome (HS) is a rare disease characterized by aortic stenosis (AS), gastrointestinal bleeding, and acquired von Willebrand syndrome.

A 91-year-old woman with anemia and (recurrent) AS with subsequent surgical bioprosthetic aortic valve replacement presented with exertional chest tightness. Work-up revealed marked anemia with hemoglobin of 6.8 g/dL, a degenerative bioprosthetic aortic valve with moderate AS, multiple bleeding cecal angiodysplastic lesions, and platelet dysfunction, supporting a diagnosis of HS. Aortic valve replacement was deferred. Conservative treatment included endoscopic ablation of angiodysplasias, blood transfusions, and iron supplementation.

Existing guidelines recommend aortic valve replacement for symptomatic severe AS, but no specific recommendations for moderate bioprosthetic valve AS with HS exist. This creates a clinical gap with individualized treatment.

HS is under-recognized; treatment of HS in the context of moderate bioprosthetic valve AS falls outside evidence-based pathways and may be managed by conservative strategies.