Disappearance of Atypical Gastric Mucosal Bleeding due to Heyde's Syndrome after Transcatheter Aortic Valve Implantation

An 82-year-old man was admitted to our hospital due to dyspnea on exertion. Blood tests showed iron deficiency anemia, and echocardiography revealed severe aortic stenosis (AS). Considering the possibility of Heyde's syndrome, esophagogastroduodenoscopy was performed to confirm the presence or absence of gastrointestinal angiodysplasia. Endoscopy revealed multiple sites of mucosal bleeding in the stomach without angiodysplasia or mucosal erosion. Although it was an atypical endoscopic finding, we diagnosed gastric mucosal bleeding associated with Heyde's syndrome. Since no atypical blood vessels could be found, endoscopic treatment was not performed, and only transcatheter aortic valve implantation (TAVI) for aortic valve stenosis was performed. TAVI immediately improved the dyspnea on exertion, and follow-up endoscopy 4 months after TAVI showed the disappearance of the multifocal mucosal bleeding in the stomach. Heyde's syndrome is characterized by AS, acquired deficiency or dysfunction of von Willebrand factor, and gastrointestinal angiodysplasia; however, the exact diagnostic criteria have not been established. This is a case of mucosal bleeding due to Heyde's syndrome, without the typical endoscopic image of angiodysplasia. Cardiologists and gastroenterologists need to consider the possibility of Heyde's syndrome in AS patients with atypical gastrointestinal bleeding on endoscopy.