title: An extreme case of Heyde syndrome.
abstract: BACKGROUND
  The Heyde syndrome consists of the association of gastrointestinal bleeding from angiodysplasia with aortic valve stenosis. Its existence has been repeatedly questioned or reconfirmed, and the proposed underlying mechanism is the degradation of a coagulation factor caused by the stenotic valve, which facilitates bleeding from angiodysplastic lesions.
  
  
  METHODS
  We report the case of a patient with severe recurrent small-intestinal bleeding from angiodysplasia, diagnosed by a videocapsule, and aortic valve stenosis. He underwent aortic valve replacement with a bioprosthesis as an extreme life-saving procedure. The operation was followed by the cessation of bleeding for 10 months, then bleeding recurred, emergency bowel resection was needed, and was followed by a chain of events which led to the patient's death.
  
  
  CONCLUSIONS
  This case offers an extreme example of the challenging issues still involved in the management of patients with Heyde syndrome.
authors.affiliation: Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of Sacred Heart School of Medicine, Rome, Italy. ivo.giovannini@rm.unicatt.it
authors.forename: Ivo
authors.initials: I
authors.lastname: Giovannini
authors.forename: Carlo
authors.initials: C
authors.lastname: Chiarla
authors.forename: Marino
authors.initials: M
authors.lastname: Murazio
authors.forename: Gennaro
authors.initials: G
authors.lastname: Clemente
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
mesh_terms: D000368:Aged; D016888:Angiodysplasia / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D053704:Capsule Endoscopy; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012008:Recurrence; D013577:Syndrome