-Case Reports-

Aortic Valve Replacement for the Management of Heyde Syndrome: A Case Report

Akihiko Shibamoto¹, Hideto Kawaratani¹, Takuya Kubo¹, Norihisa Nishimura¹, Shinya Sato¹, Kenichiro Seki¹, Yasuhiko Sawada¹, Hiroaki Takaya¹, Yasushi Okura¹, Kousuke Takeda¹, Masakazu Uejima¹, Tadashi Namisaki¹, Kei Moriya¹, Akira Mitoro¹, Junichi Yamao² and Hitoshi Yoshiji¹

¹Third Department of Internal Medicine, Nara Medical University, Nara, Japan
²Department of Endoscopy, Nara Medical University, Nara, Japan

Heyde syndrome describes the triad of aortic stenosis, acquired coagulopathy, and anemia due to bleeding from intestinal angiodysplasia. An 87-year-old man with iron deficiency anemia due to melena was admitted to our hospital. On examination, a systolic murmur was heard and echocardiography confirmed the presence of aortic stenosis. Esophagogastroduodenoscopy and colonoscopy were unremarkable. Capsule endoscopy and double balloon endoscopy revealed angiodysplasia throughout the small intestine. Laboratory investigations were significant for reduced plasma levels of high molecular weight von Willebrand factor multimers. On the basis of these findings, the patient was diagnosed with Heyde syndrome. The patient required frequent blood transfusions because of the intestinal bleeding, and underwent bioprosthetic aortic valve replacement. Twenty months after the operation, the gastrointestinal bleeding resolved and the patient no longer required blood transfusions. This is the first case report to describe an improvement in bleeding from angiodysplasia, one year after aortic valve replacement. It demonstrates the effective treatment of Heyde syndrome with aortic valve replacement, and highlights the importance of considering this differential diagnosis when evaluating patients presenting with repeated episodes of gastrointestinal bleeding and a concurrent systolic murmur.

J Nippon Med Sch 2017; 84: 193-197

Keywords
acquired von Willebrand's syndrome, aortic stenosis, gastrointestinal bleeding, Heyde syndrome

Correspondence to
Hideto Kawaratani, MD, PhD, Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
kawara@naramed-u.ac.jp

Received, January 23, 2017
Accepted, April 17, 2017