Resumo
Heyde’s Syndrome is a clinical condition characterized by the coexistence of aortic stenosis and gastrointestinal bleeding, typically associated with angiodysplasia. This study reviews recent literature, highlighting the relationship between aortic stenosis and the degradation of von Willebrand factor (vWF), leading to the development of acquired von Willebrand disease (AVWD). The review addresses the key biochemical parameters and diagnostic methods used for identifying the syndrome, emphasizing the importance of echocardiography for detecting aortic stenosis and multimer analysis of vWF for confirming AVWD. The analysis includes discussions on the diagnostic challenges and clinical implications of the syndrome, proposing guidelines that could improve therapeutic management and reduce associated morbidity. It concludes that an integrated, evidence-based diagnostic approach is essential for the early detection and effective treatment of Heyde’s Syndrome.
Referências
BASAK, D. K.; GOMES, R. R.; ARFIN, S., Md. Heyde’s syndrome: Rarely heard and often missed. Advanced Research in Gastroenterology & Hepatology, Vol. 2, No. 4, 2017. DOI: 10.19080/argh.2017.02.555592.
BLACKSHEAR, J. L. et al. Indexes of von Willebrand Factor as Biomarkers of Aortic Stenosis Severity (from the Biomarkers of Aortic Stenosis Severity [BASS] Study). The American Journal of Cardiology, v. 111, n. 3, p. 374-381, 2013. DOI: 10.1016/j.amjcard.2012.10.015.
BUDDE, U.; SCHNEPPENHEIM, R. Acquired von Willebrand syndrome in patients with high shear stress: from quantitative loss of von Willebrand factor to qualitative defects. Seminars in Thrombosis and Hemostasis, v. 34, n. 5, p. 520-528, 2008. DOI: 10.1055/s-0029-1145245.
CARITÀ, P.; COPPOLA, G.; NOVO, G. et al. Aortic stenosis: insights on pathogenesis and clinical implications. Journal of Geriatric Cardiology, v. 13, p. 489-498, 2016. DOI: 10.11909/j.issn.1671-5411.2016.06.001.
GIANNINI, S. et al. Acquired von Willebrand syndrome type 2A in a JAK2-positive essential thrombocythemia - affected member of a large von Willebrand disease family with a novel autosomal dominant A1716P mutation. Thrombosis and Haemostasis, v. 105, n. 5, p. 921-924, 2011. DOI: 10.1160/th10-08-0517.
GOLA, W.; LELONEK, M. Clinical implication of gastrointestinal bleeding in degenerative aortic stenosis: an update. Cardiology Journal, v. 17, n. 4, p. 330-334, 2010.
GRAGNANO, F. et al. Von Willebrand Factor as a Novel Player in Valvular Heart Disease: From Bench to Valve Replacement. Angiology, v. 69, n. 2, p. 103-112, 2017. DOI: 10.1177/0003319717708070.
GRIMARD, B. H.; SAFFORD, R. E.; BURNS, E. L. Aortic stenosis: diagnosis and treatment. American Family Physician, v. 93, p. 371-378, 2016.
HUDZIK, B.; WILCZEK, K.; GASIOR, M. Heyde syndrome: Gastrointestinal bleeding and aortic stenosis. CMAJ, v. 188, n. 2, p. 135–138, 2016. DOI: 10.1503/cmaj.150194.
ISLAM, S. et al. Heyde’s syndrome: a critical review of the literature. Journal of Heart Valve Disease, v. 20, n. 4, p. 366-375, 2011.
MICHOT, J. M. et al. Severe gastro-intestinal angiodysplasia in context of Heydes syndrome durably cured after aortic valve replacement. La Presse Médicale, v. 41, n. 7–8, p. 763–766, 2012. DOI: 10.1016/j.lpm.2011.10.012.
MOHEE, A. et al. Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018. Cardiology Journal, v. 27, p. 72-77, 2020. DOI: 10.5603/CJ.a2018.0068.
NATORSKA, J. et al. Increased thrombin generation and platelet activation are associated with deficiency in high molecular weight multimers of von Willebrand factor in patients with moderate-to-severe aortic stenosis. Heart, v. 97, n. 24, p. 2023-2028, 2011. DOI: 10.1136/hrt.2010.217273.
RANDI, A. M.; LAFFAN, M. A. Von Willebrand factor and angiogenesis: basic and applied issues. Journal of Thrombosis and Haemostasis, vol. 15, no. 1, p. 13–20 (2017). doi: 10.1111/jth.13551.
THOMPSON, J. L. et al. Risk of recurrent gastrointestinal bleeding after aortic valve replacement in patients with Heyde syndrome. The Journal of Thoracic and Cardiovascular Surgery, v. 144, n. 1, p. 112-116, 2012. DOI: 10.1016/j.jtcvs.2011.05.034.
TIEDE, A. et al. Diagnostic workup of patients with acquired von Willebrand syndrome: A retrospective single-centre cohort study. Journal of Thrombosis and Haemostasis, vol. 6, no. 4, p. 569–576, 2008. DOI: 10.1111/j.1538-7836.2008.02909.x.
TSUCHIYA, S. et al. Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde’s Syndrome: A Case Report and Review of the Literature. Journal of Atherosclerosis and Thrombosis, v. 27, n. 3, p. 271-277, 2020.
VAN BELLE, E. et al. von Willebrand factor and management of heart valve disease: JACC Review Topic of the Week. Journal of the American College of Cardiology, v. 73, p. 1078-1088, 2019. DOI: 10.1016/j.jacc.2018.12.045.
VENERITO, M. et al. Gastrointestinal bleeding and cardiovascular diseases: Systematic review and meta-analysis. Journal of Gastroenterology and Hepatology, v. 36, n. 3, p. 746-753, 2021.
VINCENTELLI, A. et al. Acquired Von Willebrand Syndrome in Aortic Stenosis. New England Journal of Medicine, v. 349, n. 4, p. 343-349, 2003. DOI: 10.1056/nejmoa022831.
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Marcelo Flavio Gomes Jardim Filho