JACC. Case reports · 2026
Transcatheter Management of Severe Aortic Stenosis, Acute Pulmonary Embolism, and Gastrointestinal Bleeding.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Wang Zhouming, Xie Taotao, Ding Xin, Su Yanbin, Liu Yajun, Zhang Na, Yang Zhenwen
Аннотация
BACKGROUND: The concurrent presentation of severe aortic stenosis (AS), acute pulmonary embolism (PE), and gastrointestinal bleeding creates a clinical dilemma where treating one condition may exacerbate another.
CASE SUMMARY: A 72-year-old woman presented with fatigue, palpitations, and melena. She was found to have severe AS, bilateral acute PE, and a bleeding duodenal ulcer. After initial stabilization with transfusion, we used a staged multidisciplinary approach: catheter-directed thrombectomy with adjunctive balloon angioplasty for residual stenosis, followed by transfemoral transcatheter aortic valve replacement.
DISCUSSION: This case illustrates the challenges of coexisting AS, gastrointestinal bleeding, and PE. Although Heyde syndrome was considered a possible unifying mechanism, absent angiodysplasia and von Willebrand factor testing preclude definitive diagnosis. A staged, physiology-driven strategy prioritized immediate threats and enabled safe definitive therapy.
TAKE-HOME MESSAGES: In patients with competing thrombotic and bleeding pathologies, a staged, physiology-first approach prioritizing the most immediate threat enables safe sequential intervention. Percutaneous techniques minimize cumulative risk in high-risk patients.
CASE SUMMARY: A 72-year-old woman presented with fatigue, palpitations, and melena. She was found to have severe AS, bilateral acute PE, and a bleeding duodenal ulcer. After initial stabilization with transfusion, we used a staged multidisciplinary approach: catheter-directed thrombectomy with adjunctive balloon angioplasty for residual stenosis, followed by transfemoral transcatheter aortic valve replacement.
DISCUSSION: This case illustrates the challenges of coexisting AS, gastrointestinal bleeding, and PE. Although Heyde syndrome was considered a possible unifying mechanism, absent angiodysplasia and von Willebrand factor testing preclude definitive diagnosis. A staged, physiology-driven strategy prioritized immediate threats and enabled safe definitive therapy.
TAKE-HOME MESSAGES: In patients with competing thrombotic and bleeding pathologies, a staged, physiology-first approach prioritizing the most immediate threat enables safe sequential intervention. Percutaneous techniques minimize cumulative risk in high-risk patients.