Did Angiodysplasia Associated with Heyde's Syndrome Disappear Spontaneously?: A case report

Abstract Background: Heyde’s syndrome can be easily overlooked or misjudged in clinical practice because it shares common clinical manifestations with multiple diseases and because of the limited accuracy of the corresponding examinations for diagnosing Heyde’s triad. Moreover, aortic valve replacement is often delayed in these patients because of the contradiction between anticoagulation and haemostasis. Herein, we present a rare case of atypical Heyde's syndrome. The patient's severe intermittent gastrointestinal bleeding was not completely cured even after a local enterectomy. In the absence of direct evidence of acquired von Willebrand syndrome (AVWS) or angiodysplasia, her long-standing gastrointestinal bleeding was finally stopped after receiving transcatheter aortic valve implantation (TAVI).Case presentation: A 64-year-old female suffered from refractory gastrointestinal bleeding and exertional dyspnoea. Local enterectomy was performed owing to persistent haemorrhage and repeated transfusions; subsequently, histological examination revealed angiodysplasia. Heyde's syndrome was not suspected until 3 years later, at which time the patient started bleeding again and was also found to have severe aortic valve stenosis on echocardiography. TAVI was consequently performed when the patient was in a stable condition even there was no evidence of angiodysplasia and AVWS at that time. The post-procedure and follow-up were uneventful.Conclusions: The visible characteristics of angiodysplasia or a shortage of HMWM-vWFs should not be indispensable for the clinical diagnosis of Heyde's syndrome. Enterectomy could be a bridging therapy for aortic valve replacement in patients with severe haemorrhage, and TAVI may benefit high-risk patients who are stable.