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Aortic Valve Replacement for Patients with Heyde Syndrome: A Literature Review

Huili Li1, Peishuang Lin2, Yuntai Yao3*   

  1. 1Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang 050000, China

    2Department of Anesthesiology, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou 362000, China 3Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China

Abstract:

Objective To explore the characteristics and clinical outcomes of patients with Heyde syndrome (HS) who undergo aortic valve replacement (AVR).

Methods Electronic databases PubMed, Embase, Ovid, WANFANG, VIP and CNKI were searched to identify all case reports of HS patients undergoing AVR surgery, using different combinations of search terms “Heyde syndrome”, “gastrointestinal bleeding”, “aortic stenosis”, and “surgery”. Three authors independently extracted the clinical data including the patients' characteristics, aortic stenosis severity, gastrointestinal bleeding sites, surgical treatments and prognosis.

Results Finally, 46 case reports with 55 patients aging from 46 years to 87 years, were determined eligible and included. Of them, 1 patient had mild aortic stenosis, 1 had moderate aortic stenosis, 42 had severe aortic stenosis, and 11 were not mentioned. Gastrointestinal bleeding was detected in colon (n=8), jejunum (n=6), ileum (n=4), cecum (n=3), duodenal (n=3) and multiple sites (n=8). No specific bleeding site was identified in 23 patients. Preoperative hemoglobin ranged from 43 to 117 g/L. The level of high molecule weight (HMW) von Willebrand factor (vWF) examined in 16 patients was decreased in all cases but one. Of the 55 patients, 43 underwent AVR, and 12 received transcatheter AVR. Aortic valves of 14 cases were replaced by mechanical valves, and 33 cases by biological valves. All patients recovered well during the follow-up, except 5 patients. One patient had perivalvular leakage and gastrointestinal bleeding after AVR, and underwent second AVR. Two patients had recurrent gastrointestinal bleeding. Two patients died of life-threatening acute subdural hematoma and multiple organ failure, respectively.

Conclusion HS is a rare syndrome characterized by aortic stenosis and gastrointestinal bleeding. AVR is an effective treatment for HS.

Key words: Heyde syndrome;, gastrointestinal bleeding, aortic valve stenosis

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