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Ambivalent effect of aortic stenosis on von Willebrand factor and thrombin generation. Is transvalvular gradient the guilty party?
  1. Thierry Le Tourneau1,
  2. Joke Breyne2,
  3. Sophie Susen2
  1. 1Inserm U915, Institut du Thorax, University of Nantes, Nantes, France
  2. 2University of Lille, EA 2693, Haematology Department, Lille, France
  1. Correspondence to Thierry Le Tourneau, Laboratoire d'Explorations Fonctionnelles, Hotel Dieu, 1 Place Alexis Ricordeau, Nantes Cedex 44093, France; thletourneau{at}

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Aortic valve sclerosis-stenosis is the most common valvular pathology in industrialised countries, evolving from aortic valve sclerosis into aortic stenosis (AS). Aortic valve sclerosis is present in 25% and AS in 2% of people aged >65 years.

Heyde syndrome is an acquired and intricate pathology encountered in AS and in the obstructive form of hypertrophic cardiomyopathy (HOCM).1–3 In its initial description Heyde syndrome is a syndrome of AS associated with gastrointestinal (GI) bleeding of idiopathic origin, which was subsequently linked to angiodysplasia. Angiodysplasia is predominantly observed in the elderly and is characterised by small vascular dilatations of GI submucosal veins and capillaries, ultimately leading to arteriovenous communications. This vascular malformation is more often multiple than single and is regarded as a GI degenerative ageing process involving mainly the caecum and the right colon. Angiodysplasia is a fortuitous finding in endoscopy in 2–3% of non-bleeding patients aged >65 years but is also widely recognised as a major cause of digestive bleeding in elderly people. In patients with GI bleeding angiodysplasia is found in 2.6–6.2% of patients by colonoscopic examination.4

Bleeding can occur in patients with severe AS or HOCM when there is a pathological association with a bleeding-prone lesion, the most common being GI angiodysplasia. The pathological association of these two diseases is not rare and 2–3% of patients aged >65 years with severe AS would also have …

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