Abstract
BACKGROUND: Heyde's syndrome is known as a combination of gastrointestinal (GI) bleeding and aortic valve stenosis. However, there are no reports of an association between GI bleeding and bioprosthetic valve stenosis initially occurred after aortic valve replacement (AVR), even though there are several reports that GI bleeding due to native aortic valve stenosis disappeared after AVR, and GI bleeding recurred due to bioprosthetic valve stenosis or patient-prosthesis mismatch. CASE PRESENTATION: An 80-year-old woman who was on hemodialysis for 13 years had undergone AVR with a bioprosthetic valve for aortic regurgitation 3 years prior. She was admitted with acute heart failure and anemia that required repeated blood transfusions. Capsule endoscopy revealed multiple active hemorrhages of the small intestine due to angiodysplasia. Echocardiography showed severe bioprosthetic valve stenosis in the aortic valve position as a result of structural valve deterioration (SVD). Because Heyde's syndrome was strongly suspected even though gel electrophoresis analysis of von Willebrand factor multimers, the gold standard examination for the definitive diagnosis of Heyde's syndrome, was not performed, a redo AVR with a new bioprosthetic valve was performed. After the second AVR, both the heart failure and anemia due to GI bleeding promptly improved. CONCLUSIONS: Bioprosthetic valve stenosis due to SVD can bring GI bleeding just as in native aortic valve stenosis. Redo AVR is a promising treatment if the combination of GI bleeding and valve stenosis in the aortic valve position appears even after AVR.