Renmin Hospital of Wuhan University: Transfemoral TAVR for Complex Heyde Syndrome

Heyde syndrome—the coexistence of severe aortic stenosis (AS) and gastrointestinal bleeding secondary to intestinal angiodysplasia—is frequently underdiagnosed or mistaken for an isolated gastrointestinal pathology.

Recently, the structural heart team at Renmin Hospital of Wuhan University, in close collaboration with echocardiography, anesthesiology, and cardiac surgery departments, successfully delivered a minimally invasive transcatheter intervention for an 84-year-old female presenting with severe calcific aortic stenosis (AVA 0.74 cm², mean gradient 48 mmHg), profound hemorrhagic anemia (Hb 52 g/L), and decompensated heart failure.

Clinical Challenge & Pathophysiology

The core clinical contradiction lay in the reciprocal relationship between heart failure and severe anemia: aggressive fluid and blood replacement carried a high risk of precipitating acute pulmonary edema, while uncorrected anemia worsened myocardial ischemia.

Mechanistically, high-velocity turbulent blood flow through the stenotic aortic valve generates extreme pathologic shear stress. This causes mechanical degradation of high-molecular-weight von Willebrand factor (vWF) multimers, leading to acquired coagulopathy and recurrent gastrointestinal bleeding. Relieving the mechanical stenosis is the only definitive approach to break this vicious cycle.

Standardized MDT Clinical Pathway

• Multimodal Imaging Assessment: Comprehensive CT analysis of annular calcification patterns and peripheral vascular access; echocardiographic profiling of ventricular dynamics; establishment of routine surgical backup.
• Volume & Tolerance Optimization: Meticulous perioperative fluid balance to gradually correct profound anemia while preventing acute volume overload and pulmonary edema.
• Transfemoral TAVR: Minimally invasive transcatheter valve deployment under real-time multimodal monitoring to promptly relieve left ventricular outflow tract obstruction.
• Etiological Bleeding Control: Eliminating transvalvular shear stress halted the pathologic cleavage of vWF multimers, enabling spontaneous recovery of endogenous primary hemostasis.

Clinical Outcomes

Post-procedure, the prosthetic valve demonstrated excellent hemodynamic function, with the mean transvalvular gradient decreasing from 48 mmHg to 5 mmHg with trace paravalvular leak. During follow-up, active GI bleeding ceased completely, fecal occult blood turned negative, and hemoglobin stabilized at ~100 g/L without further transfusions.

Clinical Significance: This case highlights that TAVR is not only a hemodynamic reconstruction technique, but also an etiological cure for acquired bleeding disorders like Heyde syndrome. For elderly patients presenting with unexplained anemia and recurrent GI bleeding, aortic valve screening should be prioritized.