Gastric Antral Vascular Ectasia Syndrome With Aortic Stenosis: A Twist on Heyde Syndrome?

Overview

Journal J Med Cases

Specialty General Medicine

Date 2025 Jan 6

PMID 39759164

Authors

Lefika Bathobakae

Noman Khalid

Sacide S Ozgur

Devina Adalja

Rajkumar Doshi

Gabriel Melki

Kamal Amer

Yana Cavanagh

Walid Baddoura

Affiliations

Soon will be listed here.

Abstract

Heyde syndrome is a triad of aortic stenosis (AS), gastrointestinal (GI) bleeding from angiodysplasia, and acquired von Willebrand disease (vWD). It is hypothesized that stenotic aortic valves cleave von Willebrand factor (vWF) multimers, predisposing patients to bleeding from GI angiodysplasias. This hypothesis is supported by the observation that aortic valve replacement often leads to the resolution of GI bleeding. Heyde syndrome is typically described in the context of AS and small bowel angiodysplasias (Dieulafoy's lesion, intestinal vascular malformation, and arteriovenous malformations). However, data on AS and gastric antral vascular ectasia (GAVE) association are scarce. GAVE is a vascular anomaly characterized by ectatic capillaries, arterioles, and venules, which can lead to upper GI bleeding. The paucity of data on GAVE-AS association may lead to underdiagnosis and/or under-reporting. Herein, we describe two cases of GAVE-AS that were diagnosed and treated at our institution. This case series focuses on patient presentations and clinical outcomes and aims to raise awareness about this rare association.

References

Morrisroe K, Hansen D, Stevens W, Sahhar J, Ngian G, Hill C . Gastric antral vascular ectasia in systemic sclerosis: a study of its epidemiology, disease characteristics and impact on survival. Arthritis Res Ther. 2022; 24(1):103. PMC: 9087964. DOI: 10.1186/s13075-022-02790-1. View

Jehangir A, Pathak R, Ukaigwe A, Donato A . Association of aortic valve disease with intestinal angioectasia: data from the Nationwide Inpatient Sample. Eur J Gastroenterol Hepatol. 2018; 30(4):438-441. DOI: 10.1097/MEG.0000000000001068. View

Vincentelli A, Susen S, Le Tourneau T, Six I, Fabre O, Juthier F . Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med. 2003; 349(4):343-9. DOI: 10.1056/NEJMoa022831. View

Desai R, Parekh T, Singh S, Patel U, Fong H, Zalavadia D . Alarming Increasing Trends in Hospitalizations and Mortality With Heyde's Syndrome: A Nationwide Inpatient Perspective (2007 to 2014). Am J Cardiol. 2019; 123(7):1149-1155. DOI: 10.1016/j.amjcard.2018.12.043. View

Rosa V, Barbosa Ribeiro H, Cordeiro Fernandes J, De Santis A, Sobreira Spina G, Paixao M . Heyde's Syndrome: Therapeutic Strategies and Long-Term Follow-Up. Arq Bras Cardiol. 2021; 117(3):512-517. PMC: 8462952. DOI: 10.36660/abc.20200371. View

Blackshear J . Heyde Syndrome: Aortic Stenosis and Beyond. Clin Geriatr Med. 2019; 35(3):369-379. DOI: 10.1016/j.cger.2019.03.007. View

Sinha S, Castro D, Shakil S . Medical Management of Heyde Syndrome. Cureus. 2021; 13(1):e12551. PMC: 7863051. DOI: 10.7759/cureus.12551. View

Peng M, Guo X, Yi F, Shao X, Wang L, Wu Y . Endoscopic treatment for gastric antral vascular ectasia. Ther Adv Chronic Dis. 2021; 12:20406223211039696. PMC: 8366108. DOI: 10.1177/20406223211039696. View

Lourdusamy D, Mupparaju V, Sharif N, Ibebuogu U . Aortic stenosis and Heyde's syndrome: A comprehensive review. World J Clin Cases. 2021; 9(25):7319-7329. PMC: 8464459. DOI: 10.12998/wjcc.v9.i25.7319. View

10.

Sugimoto S, Takamura T . Disappearance of Atypical Gastric Mucosal Bleeding due to Heyde's Syndrome after Transcatheter Aortic Valve Implantation. Case Rep Gastroenterol. 2022; 16(1):165-170. PMC: 9035938. DOI: 10.1159/000522640. View

11.

Lageju N, Uprety P, Neupane D, Bastola S, Lama S, Panthi S . Gastric antral vascular ectasia (Watermelon stomach); an unusual cause of upper gastrointestinal bleeding in elderly: A case report. Ann Med Surg (Lond). 2022; 82:104733. PMC: 9577822. DOI: 10.1016/j.amsu.2022.104733. View

12.

Fortuna L, Bottari A, Bisogni D, Coratti F, Giudici F, Orlandini B . Gastric Antral Vascular Ectasia (GAVE) a case report, review of the literature and update of techniques. Int J Surg Case Rep. 2022; 98:107474. PMC: 9386635. DOI: 10.1016/j.ijscr.2022.107474. View

13.

Waldschmidt L, Drolz A, Heimburg P, Gossling A, Ludwig S, Voigtlander L . Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol. 2021; 110(12):1939-1946. PMC: 8639542. DOI: 10.1007/s00392-021-01905-z. View

14.

Jamil D, Tran H, Mansoor M, Bbutt S, Satnarine T, Ratna P . Multimodal Treatment and Diagnostic Modalities in the Setting of Heyde's Syndrome: A Systematic Review. Cureus. 2022; 14(8):e28080. PMC: 9477546. DOI: 10.7759/cureus.28080. View

15.

Saha B, Wien E, Fancher N, Kahili-Heede M, Enriquez N, Velasco-Hughes A . Heyde's syndrome: a systematic review of case reports. BMJ Open Gastroenterol. 2022; 9(1). PMC: 9086603. DOI: 10.1136/bmjgast-2021-000866. View

16.

Abdelmaseih R, Thakker R, Abdelmasih R, Ali A, Hasan M . Perspectives on Heyde's Syndrome and Calcific Aortic Valve Disease. Curr Probl Cardiol. 2021; 47(10):100930. DOI: 10.1016/j.cpcardiol.2021.100930. View

17.

Dosi R, Ambaliya A, Patell R, Sonune N . Gastric antral vascular ectasia with aortic stenosis: Heydes syndrome. Indian J Med Sci. 2013; 66(3-4):86-9. View

18.

Mondal S, Hollander K, Ibekwe S, Williams B, Tanaka K . Heyde Syndrome-Pathophysiology and Perioperative Implications. J Cardiothorac Vasc Anesth. 2020; 35(11):3331-3339. DOI: 10.1053/j.jvca.2020.10.003. View

19.

Kichloo A, Solanki D, Singh J, Dahiya D, Lal D, Haq K . Gastric Antral Vascular Ectasia: Trends of Hospitalizations, Biodemographic Characteristics, and Outcomes With Watermelon Stomach. Gastroenterology Res. 2021; 14(2):104-111. PMC: 8110233. DOI: 10.14740/gr1380. View

20.

Flood V . Perils, problems, and progress in laboratory diagnosis of von Willebrand disease. Semin Thromb Hemost. 2013; 40(1):41-8. PMC: 3987108. DOI: 10.1055/s-0033-1363166. View