Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018

Cardiol J. 2020;27(1):72-77. doi: 10.5603/CJ.a2018.0068. Epub 2018 Jul 16.

Abstract

Angiodyplasia and aortic stenosis are both conditions that are highly prevalent in elderly people and can often co-exist. Recent studies suggest that this association is related to subtle alterations in plasma coagulation factors. The von Willebrand factor is the strongest link between aortic stenosis and bleeding associated with gastrointestinal angiodysplasia. With an ageing population, the disease burden of aortic stenosis and its association with angiodysplasia of the bowel makes this an incredibly underdiagnosed yet important condition. Clinicians should be aware of this association when dealing with elderly patients presenting either with unexplained anemia, gastrointestinal bleeding or with aortic stenosis. A high index of suspicion and appropriate diagnostic techniques followed by appropriate and prompt treatment could be life-saving. No clear guidelines exist on management but surgical aortic valve replacement is thought to offer the best hope for long-term resolution of bleeding. With a growing number of technological armamentarium in the management of such patients, especially with the advent of transcatheter aortic valve implantation, new options can be offered even to elderly patients with comorbidities for whom conventional surgery would have been impossible.

Keywords: Heyde’s syndrome; angiodysplasia; aortic stenosis; transcatheter aortic valve implantation; von Willebrand factor.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anemia / diagnosis
  • Anemia / epidemiology
  • Anemia / prevention & control*
  • Angiodysplasia / diagnosis
  • Angiodysplasia / epidemiology
  • Angiodysplasia / therapy*
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / epidemiology
  • Aortic Valve Stenosis / surgery*
  • Comorbidity
  • Female
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / epidemiology
  • Gastrointestinal Hemorrhage / prevention & control*
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Hemostatic Techniques* / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome