Trancatheter Aortic Valve Implantation in the Treatment of Heyde's Syndrome: A Case Report

Abstract

Calcified aortic stenosis is the most common valvulopathy of the elderly. Its association with angiodysplasia and digestive bleeding is known as Heyde syndrome. This clinical case highlights the importance of the diagnosis of this syndrome whose complications can be fatal. The cessation of gastrointestinal bleeding is often remarkable after aortic valve replacement. Transcatheter aortic valve implantation (TAVI) can represents a good alternative to surgical valve replacement, especially in patients with high surgical risk. We report a case of 62-year-old patient, admitted for management of global cardiac decompensation on a tight aortic stenosis, confirmed by transthoracic echocardiography as well as a few episodes of syncope. He had a history of repeated lower digestive hemorrhages that required several transfusions. The evolution was marked by the appearance of heavy rectal bleeding on cecum angiodysplasia lesions confirmed by colonoscopy. The association of digestive bleeding and aortic stenosis raised the diagnosis of Heyde syndrome. An assay of von Willebrand factor (vWF) antigen, vWF binding collagen activity and their ratio confirmed a qualitative deficiency of vWF type 2A. The proposed treatment was TAVI because of the high surgical risk and the patient's refusal of the surgery. The evolution at 1 month post TAVI was marked by the improvement of hemostatic parameters related to the vWF and the disappearance of cardiac symptomatology. The cessation of gastrointestinal bleeding in Heyde's syndrome is conditioned by percutaneous aortic valve replacement in the high-risk surgical subject with a good clinical and biological evolution.