• Akihiko Shibamoto, Hideto Kawaratani, Takuya Kubo, Norihisa Nishimura, Shinya Sato, Kenichiro Seki, Yasuhiko Sawada, Hiroaki Takaya, Yasushi Okura, Kousuke Takeda, Masakazu Uejima, Tadashi Namisaki, Kei Moriya, Akira Mitoro, Junichi Yamao, and Hitoshi Yoshiji.
• Third Department of Internal Medicine, Nara Medical University.
• J Nippon Med Sch. 2017 Jan 1; 84 (4): 193-197.

AbstractHeyde 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.

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