Heyde Syndrome in Moderate Bioprosthetic Aortic Valve Stenosis: A Twist in the Valve.

backgroundHeyde syndrome (HS) is a rare disease characterized by aortic stenosis (AS), gastrointestinal bleeding, and acquired von Willebrand syndrome. CASE SUMMARY: A 91-year-old woman with anemia and (recurrent) AS with subsequent surgical bioprosthetic aortic valve replacement presented with exertional chest tightness. Work-up revealed marked anemia with hemoglobin of 6.8 g/dL, a degenerative bioprosthetic aortic valve with moderate AS, multiple bleeding cecal angiodysplastic lesions, and platelet dysfunction, supporting a diagnosis of HS. Aortic valve replacement was deferred. Conservative treatment included endoscopic ablation of angiodysplasias, blood transfusions, and iron supplementation. DISCUSSION: Existing guidelines recommend aortic valve replacement for symptomatic severe AS, but no specific recommendations for moderate bioprosthetic valve AS with HS exist. This creates a clinical gap with individualized treatment. TAKE-HOME MESSAGE: HS is under-recognized; treatment of HS in the context of moderate bioprosthetic valve AS falls outside evidence-based pathways and may be managed by conservative strategies.