A case of gastrointestinal bleeding associated with calcific aortic stenosis
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Calcific aortic stenosis (AS) is linked to gastrointestinal bleeding in Western countries. This case report highlights the first documented association of AS and gastrointestinal bleeding in Japan, confirmed postmortem.
Area of Science:
- Cardiology
- Gastroenterology
- Pathology
Background:
- Calcific aortic stenosis (AS) is a common valvular heart disease.
- Gastrointestinal (GI) bleeding is a known, though infrequent, complication in Western patients with AS.
- The association between AS and GI bleeding has not been previously reported in Japan.
Observation:
- An 84-year-old female with severe AS presented with recurrent rectal bleeding.
- Despite extensive investigations including endoscopy, the bleeding source remained undetected.
- The patient succumbed to progressive heart failure during hospitalization.
Findings:
- Postmortem examination confirmed severe left ventricular hypertrophy and calcific aortic stenosis.
- Microscopic analysis revealed angiodysplastic lesions in the submucosa of the gastrointestinal tract.
- This provides pathological evidence linking AS and GI bleeding.
Implications:
- This case suggests that the association between calcific aortic stenosis and gastrointestinal bleeding may occur in Japan.
- Angiodysplasia could be the underlying mechanism for GI bleeding in AS patients.
- Further research is warranted to confirm this association and explore its prevalence and pathophysiology in the Japanese population.
Abstract:
Gastrointestinal bleeding is not rare in patients with calcific aortic stenosis (AS) in Western countries, which has suggested an association between the two conditions. However, there has been no previous report of this association in Japan. In this report we describe a patient with AS who had recurrent gastrointestinal bleeding. An 84-year-old female who had been followed for severe AS presented with recurrent rectal bleeding, but the site of bleeding could not be detected despite various examinations, including endoscopy. She died of progressive heart failure during hospitalization. Postmortem examination disclosed severe left ventricular hypertrophy with calcific aortic stenosis. Microscopically, angiodysplastic lesions were observed in the submucosa throughout the gastrointestinal tract.