Letter to the Editor| Volume 127, ISSUE 2, P292-294, July 04, 2008

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Obscure gastrointestinal bleeding and calcific aortic stenosis (Heyde's syndrome)


      The coexistence of calcific aortic valve stenosis and obscure gastrointestinal bleeding secondary to intestinal angiodysplasias usually of the cecum and the ascending colon constitutes Heyde's syndrome. The pathophysiologic link between both entities has remained unclear so far but newer studies suggest that it is the result of subtle alterations in plasma coagulation factors. Cessation of the bleeding has followed replacement of the aortic valve. We describe a patient with recurrent obscure gastrointestinal bleeding, calcific aortic stenosis and intestinal angiodysplasias, and discuss the current literature.


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        • Zuckerman G.R.
        • Prakash C.
        • Askin M.P.
        • Lewis B.S.
        AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding.
        Gastroenterology. 2000; 118: 201-221
        • Heyde E.C.
        Gastrointestinal bleeding in aortic stenosis.
        N Engl J Med. 1958; 259: 196
        • Batur P.
        • Stewart W.J.
        • Isaacson J.H.
        Increased prevalence of aortic stenosis in patients with arteriovenous malformations of the gastrointestinal tract in Heyde syndrome.
        Arch Intern Med. 2003; 163: 1821-1824
        • Margulis A.R.
        Operative mesenteric angiography in the search for the site of bleeding in unexplained gastrointestinal hemorrhage.
        Surgery. 1960; 48: 534-539
        • Rogers B.H.
        Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular, and pulmonary disease.
        Gastrointest Endosc. 1980; 26: 134-138
        • Sucker C.
        The Heyde syndrome: proposal for a unifying concept explaining the association of aortic valve stenosis, gastrointestinal angiodysplasia and bleeding.
        Int J Cardiol. Jan 31 2007; 115: 77-78
        • Lewin M.B.
        • Otto C.M.
        The bicuspid aortic valve: adverse outcomes from infancy to old age.
        Circulation. Feb 22 2005; 111: 832-834
        • Iung B.
        • Baron G.
        • Butchart E.G.
        • et al.
        A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.
        Eur Heart J. 2003; 24: 1231-1243
        • Roberts W.C.
        • Ko J.M.
        Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation.
        Circulation. 2005; 111: 920-925
        • Stewart B.F.
        • Siscovick D.
        • Lind B.K.
        • et al.
        Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study.
        J Am Coll Cardiol. 1997; 29: 630-634
        • Vincentelli A.
        • Susen S.
        • Le Tourneau T.
        • et al.
        Acquired von Willebrand syndrome in aortic stenosis.
        N Engl J Med. 2003; 349: 343-349
        • Pareti F.I.
        • Lattuada A.
        • Bressi C.
        • et al.
        Proteolysis of von Willebrand factor and shear stress-induced platelet aggregation in patients with aortic valve stenosis.
        Circulation. 2000; 102: 1290-1295
        • Bounds B.C.
        • Friedman L.S.
        Lower gastrointestinal bleeding.
        Gastroenterol Clin North Am. 2003; 32: 1107-1125
        • King R.M.
        • Pluth J.R.
        • Giuliani E.R.
        The association of unexplained gastrointestinal bleeding with calcific aortic stenosis.
        Ann Thorac Surg. 1987; 44: 514-516
        • Anderson R.P.
        • McGrath K.
        • Street A.
        Reversal of aortic stenosis, bleeding gastrointestinal angiodysplasia, and von Willebrand syndrome by aortic valve replacement.
        Lancet. 1996; 347: 689-690
        • Natowitz L.
        • Defraigne J.O.
        • Limet R.
        Association of aortic stenosis and gastrointestinal bleeding (Heyde's syndrome). Report of two cases.
        Acta Chir Belg. 1993; 93: 31-33