Management challenges in Heyde syndrome: A case report of recurrent gastrointestinal bleeding and aortic stenosis in an octogenarian

Abstract

Heyde syndrome is defined by the triad of aortic stenosis, gastrointestinal bleeding from angiodysplasias, and acquired von Willebrand disease. Management of aortic stenosis in Heyde syndrome poses a unique clinical challenge, particularly in elderly patients with multiple comorbidities. We present the case of an 87-year-old woman with severe anaemia secondary to gastrointestinal bleeding, moderate-to-severe aortic stenosis, and confirmed acquired von Willebrand disease. Despite endoscopic intervention and medical management, the patient continued to experience recurrent bleeding and haemodynamic instability. Although aortic valve replacement is known to mitigate bleeding risk by correcting shear stress-induced von Willebrand factor abnormalities, the patient's frailty, atrial fibrillation, and preference for conservative management complicated decision-making. This case highlights the complexities and therapeutic dilemmas in managing aortic stenosis in Heyde syndrome, particularly balancing the risks and benefits of surgical intervention versus conservative treatment in a vulnerable population.