Percutaneous aortic valve replacement, an alternative in the treatment of atypical Heyde syndrome?

Introduction: Severe aortic stenosis is often associated with various acquired coagulopathies due to high velocity of blood passing through the narrow aortic orifice, which primarily results in Von Willebrand factor abnormalities, as well as platelet dysfunction. In addition, it has been shown that angiodysplasia of the mucous membranes is also frequent in patients with aortic stenosis, its most studied form being angiodysplasia of the gastrointestinal tract – however, it should be noted that in exceptionally rare cases angiodysplasia may manifest in atypical locations such as the nasopharyngeal mucosa. The association of these three entities: severe aortic stenosis, acquired coagulopathy and anemia secondary to gastrointestinal angiodysplasia make up Heyde syndrome.

Case presentation: A 77-year-old hypertensive dys-lipidemic patient, known with severe aortic stenosis arrives complaining of epistaxis, retrosternal pain and dyspnea, occurring at moderate exertion. Emergency bloodworks show mild anemia. The ENT consultation reveals angiodysplasia of the posterior nasal fossa, with indication for surgical therapy, but the intervention is postponed due to the severity of the aortic stenosis. As the patient is at high risk of bleeding, ESC guidelines recommend percutaneous aortic valve replacement (TAVI) thus the patient in enrolled in our institute’s TAVI waiting list. When reassessed, the patient presents pallor, shortness of breath and multiple episodes of epistaxis. Laboratory tests reveal moderate anemia. After rehidration and correction of anemia, TAVI is performed. Post-procedure, the patient’s symptoms improve and during hospitalization the patient has a single episode of epistaxis. During the 6-month follow-up we find out that the patient has presented isolated episodes of epistaxis, and the ENT control shows no signs of the lesion previously seen in the nasal fossa.

Particularity: Although Heyde syndrome is a relatively frequent pathology, nasopharyngeal localization is exceptionally rare. Aortic valve replacement should be considered in these patients to reduce or even stop bleeding episodes

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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