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Gastrointestinal Bleeding in Native and Prosthetic Valve Disease.

Abstract

Gastrointestinal bleeding with severe aortic stenosis was originally described in the 1950s by Heyde, although for years, the association was debated. Further discovery of mechanisms and the ubiquity and severity of acquired von Willebrand syndrome in the left ventricular assist device therapy have removed any doubts. At this time, gastrointestinal bleeding from intestinal angiodysplasia in patients with turbulence-related proteolysis of the highest molecular weight multimers of von Willebrand factor is now known to occur in patients with aortic stenosis, and also subaortic obstruction and associated mitral insufficiency in hypertrophic cardiomyopathy, isolated mitral and aortic insufficiency, endocarditis, and in patients with prosthetic valve dysfunction, either from stenosis or insufficiency. The degree of loss of high molecular weight multimers correlates with lesion severity, and tests of von Willebrand factor function have been proposed as important biomarkers of the severity of valve dysfunction, including in-lab testing for paravalvular leak during transcatheter aortic valve replacement. Bleeding tends to recur after endoscopic or surgical therapy, but cardiac repair is curative in the great majority.

Authors+Show Affiliations

Department of Cardiovascular Diseases, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. Blackshear.Joseph@mayo.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29397472

Citation

Blackshear, Joseph L.. "Gastrointestinal Bleeding in Native and Prosthetic Valve Disease." Current Treatment Options in Cardiovascular Medicine, vol. 20, no. 1, 2018, p. 6.
Blackshear JL. Gastrointestinal Bleeding in Native and Prosthetic Valve Disease. Curr Treat Options Cardiovasc Med. 2018;20(1):6.
Blackshear, J. L. (2018). Gastrointestinal Bleeding in Native and Prosthetic Valve Disease. Current Treatment Options in Cardiovascular Medicine, 20(1), p. 6. doi:10.1007/s11936-018-0595-1.
Blackshear JL. Gastrointestinal Bleeding in Native and Prosthetic Valve Disease. Curr Treat Options Cardiovasc Med. 2018 Feb 3;20(1):6. PubMed PMID: 29397472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastrointestinal Bleeding in Native and Prosthetic Valve Disease. A1 - Blackshear,Joseph L, Y1 - 2018/02/03/ PY - 2018/2/5/entrez PY - 2018/2/6/pubmed PY - 2018/2/6/medline KW - Gastrointestinal bleeding KW - Intestinal angiodysplasia KW - Sever aortic stenosis KW - Valvular heart disease SP - 6 EP - 6 JF - Current treatment options in cardiovascular medicine JO - Curr Treat Options Cardiovasc Med VL - 20 IS - 1 N2 - Gastrointestinal bleeding with severe aortic stenosis was originally described in the 1950s by Heyde, although for years, the association was debated. Further discovery of mechanisms and the ubiquity and severity of acquired von Willebrand syndrome in the left ventricular assist device therapy have removed any doubts. At this time, gastrointestinal bleeding from intestinal angiodysplasia in patients with turbulence-related proteolysis of the highest molecular weight multimers of von Willebrand factor is now known to occur in patients with aortic stenosis, and also subaortic obstruction and associated mitral insufficiency in hypertrophic cardiomyopathy, isolated mitral and aortic insufficiency, endocarditis, and in patients with prosthetic valve dysfunction, either from stenosis or insufficiency. The degree of loss of high molecular weight multimers correlates with lesion severity, and tests of von Willebrand factor function have been proposed as important biomarkers of the severity of valve dysfunction, including in-lab testing for paravalvular leak during transcatheter aortic valve replacement. Bleeding tends to recur after endoscopic or surgical therapy, but cardiac repair is curative in the great majority. SN - 1092-8464 UR - https://www.unboundmedicine.com/medline/citation/29397472/Gastrointestinal_Bleeding_in_Native_and_Prosthetic_Valve_Disease_ L2 - https://dx.doi.org/10.1007/s11936-018-0595-1 DB - PRIME DP - Unbound Medicine ER -