Key result
Aortic valve replacement (SAVR or TAVI) may resolve gastrointestinal bleeding in Heyde syndrome by decreasing shear stress and recovering acquired von Willebrand syndrome.
Why the study?
The mechanisms underlying the development of angiodysplasia in Heyde syndrome remain unclear, and whether treating aortic valve disease resolves gastrointestinal bleeding warrants examination.
Does aortic valve replacement (SAVR or TAVI) resolve gastrointestinal bleeding in patients with Heyde syndrome?
Does aortic valve replacement (SAVR or TAVI) resolve gastrointestinal bleeding in patients with Heyde syndrome?
Aortic valve replacement (SAVR or TAVI) is highlighted as a mechanistic treatment to resolve gastrointestinal bleeding in Heyde syndrome by correcting the underlying acquired von Willebrand syndrome.
Hypothesis-generating for valve replacement in Heyde syndrome; prospective trials needed before practice change.
Heyde syndrome is the association of aortic stenosis and gastrointestinal bleeding (GIB) from angiodysplasia, accompanied by acquired von Willebrand syndrome (aVWS) leading to decreased levels of high molecular weight multimers (HMWMs). The development of angiodysplasia in the gastrointestinal tract remains unclear. Mucosal ischaemia, high shear stress resulting from turbulence caused by the stenotic valve, and the presence of aVWS may be involved. Aortic valve replacement through surgical replacement (SAVR) or transcatheter aortic valve implantation (TAVI) leads to decreased shear stress and may resolve GIB through recovery of aVWS and potentially dissolving angiodysplasias.
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Waldschmidt et al. (2023) conducted a review in Heyde syndrome. Aortic valve replacement (SAVR or TAVI) was evaluated on Resolution of gastrointestinal bleeding. Aortic valve replacement (SAVR or TAVI) may resolve gastrointestinal bleeding in Heyde syndrome by decreasing shear stress and recovering acquired von Willebrand syndrome.
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