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Heyde syndrome—a condition involving severe aortic stenosis and gastrointestinal bleeding caused by angiodysplasias—may be more common than previously thought. According to the researchers, transcatheter aortic valve implantation (TAVI) could offer an effective treatment option.
Aortic stenosis is a condition where the valve that controls blood flow from the heart becomes too narrow and can lead to serious complications, including fatigue, breathlessness, and even heart failure. Adding to the challenge, some patients also develop angiodysplasias, fragile blood vessels in the digestive system that cause frequent bleeding. This combination of conditions is called Heyde syndrome.
Research from Radboudumc, recently published in JAMA Network Open, reveals that 75% of patients with severe aortic stenosis and iron deficiency anemia had angiodysplasias identified through capsule endoscopy. These findings suggest the syndrome is often underdiagnosed, emphasizing the need for greater attention during clinical evaluation.
The study also highlights the therapeutic potential of transcatheter aortic valve implantation (TAVI) in Heyde Syndrome. TAVI not only alleviates aortic stenosis but also significantly reduces vascular lesions linked to angiodysplasias. Among patients undergoing TAVI and follow-up capsule endoscopy, 82% experienced fewer vascular lesions, and more than half showed complete resolution. This effect surpasses conventional treatments for angiodysplasias, such as endoscopic interventions, which often offer only temporary relief.
“TAVI shows a dual benefit: it resolves aortic stenosis and reduces gastrointestinal bleeding,” says first author Lia Goltstein. “This broadens its potential applications, particularly for patients with severe gastrointestinal bleeding, who currently have limited durable treatment options.” However, the study notes that recovery is less likely in patients with multiple valvular diseases or significant paravalvular leakage, underscoring the need to optimize patient selection.
Future Directions
The research team aims to further investigate the mechanisms by which TAVI resolves vascular lesions and explore strategies to improve outcomes for patients with complicating factors. These findings could shape broader clinical use of TAVI, particularly in the management of Heyde syndrome and related conditions.
About the publication
Goltstein LCMJ, Rooijakkers MJP, Thierens NDE, et al. Gastrointestinal Angiodysplasia Resolution After Transcatheter Aortic Valve Implantation. JAMA Netw Open. 2024;7(10):e2442324. doi:10.1001/jamanetworkopen.2024.42324
