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The aortic valve. Colonic axis
Insights
Calcific aortic stenosis is linked to lower gastrointestinal bleeding in elderly patients. Aortic valve replacement may resolve bleeding, suggesting a connection beyond colonic arteriovenous malformations.
Area of Science:
- Cardiology
- Gastroenterology
- Vascular Medicine
Background:
- A correlation between calcific aortic stenosis (CAS) and lower gastrointestinal bleeding (LGIB) in elderly patients has been observed.
- Mucosal arteriovenous malformations (AVMs) in the right colon are frequently implicated as the cause of LGIB in these patients.
- Surgical management often focuses on colectomy for AVMs, but some cases of LGIB in CAS patients resolve after aortic valve replacement (AVR) alone.
Purpose of the Study:
- To review potential mechanisms linking CAS and LGIB.
- To outline diagnostic methods for LGIB in patients with CAS.
- To discuss appropriate surgical management strategies for this patient cohort.
Main Methods:
- Literature review of studies investigating the relationship between CAS and LGIB.
- Analysis of proposed pathophysiological mechanisms.
- Evaluation of diagnostic approaches for LGIB in the context of CAS.
- Review of surgical outcomes, including colectomy and AVR.
Main Results:
- Several authors suggest mucosal AVMs, typically in the right colon, cause bleeding in CAS patients.
- Reports indicate that some patients with CAS and LGIB experienced cessation of bleeding solely after AVR.
- This suggests a potential systemic or shared etiological factor beyond localized colonic AVMs.
Conclusions:
- The association between CAS and LGIB warrants further investigation into underlying mechanisms.
- Diagnostic strategies should consider the potential impact of aortic valve function on gastrointestinal bleeding.
- Aortic valve replacement may be a viable treatment option for LGIB in select patients with CAS, potentially obviating the need for colectomy.
Abstract:
In the past few years, a correlation has been recognized between calcific aortic stenosis and lower gastrointestinal bleeding in elderly patients. It has been suggested by several authors that mucosal arteriovenous malformations, usually in the right colon, are the cause of bleeding in those patients. Although attention is usually focused on doing a partial colectomy (usually right hemicolectomy) for treating colonic arteriovenous malformation bleeding, several patients with calcific aortic stenosis and gastrointestinal bleeding have been reported in whom bleeding stopped after aortic valve replacement alone. The purpose of this paper is to review the possible mechanisms of lower intestinal bleeding in patients with calcific aortic stenosis, delineate the methods of diagnosis, and finally, to outline the appropriate surgical management.