Gastrointestinal Angiodysplasia before and after Treatment of Severe Aortic Stenosis

This NEJM correspondence describes a prospective study of 50 patients with severe aortic stenosis and anemia (Hb <11 g/dL) undergoing TAVR, investigating gastrointestinal angiodysplasia (GIA), the hallmark lesion in Heyde’s syndrome. Endoscopic examination before TAVR revealed angiodysplasia in 94% of patients, most commonly in the small intestine (69%). Active bleeding was observed in 10%. Among 30 patients without gastric antral vascular ectasia (GAVE) who completed post-TAVR endoscopy, mean number of angiodysplastic lesions declined from 9.0 to 4.0 per patient, and mean lesion diameter decreased from 2.5 mm to 1.4 mm. Von Willebrand factor multimer indices improved, and no patient showed active bleeding at follow-up. Results support that TAVR reduces lesion burden and hemorrhagic risk in Heyde’s syndrome, with implications for anemia management and anticoagulation strategies.

This NEJM correspondence describes a prospective study of 50 patients with severe aortic stenosis and anemia (Hb <11 g/dL) undergoing TAVR, investigating gastrointestinal angiodysplasia (GIA), the hallmark lesion in Heyde’s syndrome. Endoscopic examination before TAVR revealed angiodysplasia in 94% of patients, most commonly in the small intestine (69%). Active bleeding was observed in 10%. Among 30 patients without gastric antral vascular ectasia (GAVE) who completed post-TAVR endoscopy, mean number of angiodysplastic lesions declined from 9.0 to 4.0 per patient, and mean lesion diameter decreased from 2.5 mm to 1.4 mm. Von Willebrand factor multimer indices improved, and no patient showed active bleeding at follow-up. Results support that TAVR reduces lesion burden and hemorrhagic risk in Heyde’s syndrome, with implications for anemia management and anticoagulation strategies.