The Syndrome of Calcific Aortic Stenosis and Gastrointestinal Bleeding: Resolution Following Aortic Valve Replacement

A syndrome exists in elderly patients of gastrointestinal tract bleeding (GIB) associated with calcific aortic stenosis (CAS). The bleeding, which may be chronic and massive, has been attributed to tiny mucosal vascular lesions which usually occur in the right colon. Selective mesenteric angiography is the best way to demonstrate the lesions, which are not seen on barium examination and may not been seen endoscopically. Previously, the recommended treatment has been segmental bowel resection, usually right hemicolectomy. Three patients have been seen with this syndrome of CAS-GIB. All three patients had severe CAS and chronic GIB and two of them had had previous, unsuccessful, intestinal operations for their GIB. All three patients had aortic valve replacement and the GIB stopped in all three patients after valve replacement. Possible mechanisms are discussed. It is concluded that aortic valve replacement is the treatment of choice for the syndrome of CAS-GIB.