Heyde syndrome in a 71-year-old man who underwent chest radiotherapy at young age
Keywords:
Angiodysplasia, Aortic valve stenosis. Colon bleeding. Heyde syndrome. Mediastinal radiotherapy.Abstract
We report the case of a 71-year-old man with diagnosis of aortic valve stenosis for ten years, who came to hospital because of breathlessness during the previous two months and recent low intestinal hemorrhage. On admission, laboratory tests and upper gastrointestinal endoscopy and colonoscopy revealed anemia and bleeding cecal angiodysplasia. The echocardiography study showed a severe aortic stenosis. Classical Heyde syndrome is described as the association of aortic stenosis, bleeding gastrointestinal angiodysplasia and secondary anemia. The antecedent of mediastinal radiotherapy for treatment of Hodgkin's disease during his youth, and eventual late cardiac adverse effects that may include aortic or mitral valve disturbances are highlighted. Electrocoagulation with argonium was performed on the sites of active bleeding during the colonoscopy. In sequence, surgical replacement by bioprothesis was done on the aortic valve. The patient remains asymptomatic, under long-term outpatient surveillance, with normal control evaluations. The aim of this case study is to emphasize difficulties related to diagnosis, and to highlight the role of endoscopy and imaging studies to confirm a hypothesis of this underestimated condition.
Downloads
References
1. BATUR P, STEWART WJ, ISAACSON JH. Increased prevalence of aortic stenosis in patients with arteriovenous malformations of the gastrointestinal tract in Heyde syndrome. Arch Intern Med 2003; 163: 1821-1824.
https://doi.org/10.1001/archinte.163.15.1821
2. GARCÍA-MARTÍN A, MORENO A, MORO C. Heyde's syndrome. Rev Esp Cardiol 2011; 64: 75-83.
https://doi.org/10.1016/j.recesp.2010.06.005
3. GOLA W, LELONEK M. Clinical implication of gastrointestinal bleeding in degenerative aortic stenosis: An update. Cardiol J 2010; 17: 330-334.
4. D'SOUZA PM, BLOSTEIN MD. Diagnosis of Heyde's syndrome by abnormal closure times despite normal von Willebrand's activity. Blood Coagul Fibrinolysis 2011; 22: 622-623.
https://doi.org/10.1097/MBC.0b013e32834a04d3
5. GÜL M, SÜRGIT O, OZAL E, ORMECI A, BAKIR I. Treatment of aortic valve stenosis and gastrointestinal bleeding by transcatheter aortic valve implantation in Heyde syndrome. Anatolian J Cardiol 2012; 12. doi:10.5152/akd.2012.224.
https://doi.org/10.5152/akd.2012.224
6. MISHRA N, MODA P, KHANNA A. Heyde's syndrome: an unusual cause of lower gastrointestinal bleeding. Ann Nigerian Med 2012; 6: 54-55.
https://doi.org/10.4103/0331-3131.100230
7. GRANEL B, SERRATRICE J, BERNIT E, CHAUDIER B, HABIB G, MESANA T et al. Heyde syndrome. Presse Med 2002; 31: 1451-1453.
8. MASSYN MW, KHAN SA. Heyde syndrome: a common diagnosis in older patients with severe aortic stenosis. Age Ageing 2009; 38: 267-270; discussion 251.
https://doi.org/10.1093/ageing/afp019
9. MORISHIMA A, MARUI A, SHIMAMOTO T, SAJI Y, TAMBARA K, NISHINA T et al. Successful aortic valve replacement for Heyde syndrome with confirmed hematologic recovery. Ann Thorac Surg 2007; 83: 287-288.
https://doi.org/10.1016/j.athoracsur.2006.05.082
10. NATOWITZ L, DEFRAIGNE JO, LIMET R. Association of aortic stenosis and gastrointestinal bleeding (Heyde's syndrome). Report of two cases. Acta Chir Belg 1993; 93: 31-33.
11. SCHEFFER SM, LEATHERMAN LL. Resolution of Heyde's syndrome of aortic stenosis and gastrointestinal bleeding after aortic valve replacement. Ann Thorac Surg 1986; 42: 477-480.
https://doi.org/10.1016/S0003-4975(10)60563-2
12. VAZ A, CORREIA A, MARTINS B, CAPELO J, FERREIRA P, HENRIQUES P et al. Heyde syndrome - the link between aortic stenosis and gastrointestinal bleeding. Rev Port Cardiol 2010; 29: 309-314.
13. KAWASE I, MATSUO T, SASAYAMA K, SUZUKI H, NISHIKAWA H. Hemolytic anemia with aortic stenosis resolved by urgent aortic valve replacement. Ann Thorac Surg 2008; 86: 645-646.
https://doi.org/10.1016/j.athoracsur.2008.01.101
14. FIGUINHA FCR, SPINA GS, TARASOUTCHI F. Síndrome de Heyde: relato de caso e revisão da literatura. Arq Bras Cardiol 2011; 96: 42-45.
https://doi.org/10.1590/S0066-782X2011000300017
15. POULIN F, SEMIONOV A, ROMÉO P, DEMERS P, PRESSACCO J, BASMADJIAN A. Extensive radiation-induced heart disease in an adult patient treated for lymphoma as a child. Can J Cardiol 2011; 27: 390.e1-4.
https://doi.org/10.1016/j.cjca.2010.12.048
16. APTER S, SHEMESH J, RAANANI P, PORTNOY O, THALER M, ZISSIN R et al. Cardiovascular calcifications after radiation therapy for Hodgkin lymphoma: computed tomography detection and clinical correlation. Coron Artery Dis 2006; 17: 145-151.
https://doi.org/10.1097/00019501-200603000-00008
17. CARLSON RG, MAYFIELD WR, NORMANN S, ALEXANDER JA. Radiation-associated valvular disease. Chest 1991; 99: 538-545.
https://doi.org/10.1378/chest.99.3.538
18. DAITOKU K, FUKUI K, ICHINOSEKI I, MUNAKATA M, TAKAHASHI D, FUKUDA I. Radiotherapy-induced aortic valve disease associated with porcelain aorta. Jpn J Thorac Cardiovasc Surg 2004; 52: 349-352.
https://doi.org/10.1007/s11748-004-0069-0
19. TAMURA A, TAKAHARA Y, MOGI K, KATSUMATA M. Radiation-induced valvular disease is the logical consequence of irradiation. Gen Thorac Cardiovasc Surg 2007; 55: 53-56.
https://doi.org/10.1007/s11748-006-0070-x
20. DOMÍNGUEZ MA, RICO M, VILA MT. Role of radiotherapy in the XXI century. An Sist Sanit Navar 2009; 32 (Suppl 2): 5-12.
Published
How to Cite
Issue
Section
License
Copyright (c) 2013 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
