Particular types of angiodysplasia include the Heyde syndrome, which consists of the association of angiodysplasia with aortic valve stenosis, in the presence of type II A of the von Willebrand disease (Khan & Massyn 2009; Pate et al 2004; Maor Roguin 2013).
Khan SA, Massyn MW (2009) Heyde syndrome: a common diagnosis in older patients with severe aortic stenosis.
Maor Roguin N (2013) Heyde syndrome: resolution of anemia after aortic valve surgery.
Also, Heyde syndrome
is characterized by calcific aortic stenosis, acquired von Willebrand disease, and angiodysplasia in colon and caecum causing gastrointestinal haemorrhage.3 So, prothrombin time, active partial thromboplastin time, von Willebrand Factor level should be evaluated in these patients.
A female patient with Heyde Syndrome
, in which gastrointestinal (GIS) bleeding is common due to GIS angiodysplasia, had Edwards SAPIEN valve placed and thus, both the aortic stenosis and GIS bleedings were treated by this intervention.
The characterization of Heyde syndrome now refers to the triad of AS, acquired coagulopathy (von Willebrand syndrome type 2A, or vWS-2A) and anemia due to bleeding from intestinal angiodysplasia.
Therefore, the prevalence of Heyde syndrome is not clearly determined and many mild cases are likely to remain undiagnosed.
It is important to keep in mind that lifelong anticoagulation will be required if a mechanical valve is considered for the AVR and this anticoagulation treatment will increase the possibility of GI bleeding in patients with Heyde syndrome. A biologic prosthesis is recommended for valve replacement as the first line treatment for AS patients with coexistent GI bleeding (4).