Recurrent Gastrointestinal Bleeding in Severe Aortic Stenosis: A Case of Heyde's Syndrome.

Heyde's syndrome is a recognized but often underdiagnosed cause of recurrent gastrointestinal bleeding in elderly patients, characterized by the triad of severe aortic stenosis, gastrointestinal angiodysplasia, and acquired von Willebrand factor (vWF) deficiency. We report the case of a 72-year-old male who presented with recurrent melena over 6 months, associated with progressive anemia and fatigue. Despite multiple hospitalizations and repeated upper gastrointestinal endoscopy and colonoscopy, no bleeding source was identified. Further evaluation revealed severe calcific aortic stenosis on echocardiography and evidence of acquired vWF deficiency. Capsule endoscopy identified angiodysplasia in the proximal jejunum. The patient was initially managed with supportive and endoscopic measures; however, due to persistent bleeding, he underwent surgical aortic valve replacement. Following valve replacement, gastrointestinal bleeding resolved completely, hemoglobin levels normalized, and vWF multimers were restored. This case highlights the importance of recognizing the diagnostic triad of Heyde's syndrome and supports aortic valve replacement as definitive therapy.