An 82-year-old man was admitted to our hospital due to
dyspnea on exertion. Blood tests showed
iron deficiency anemia, and echocardiography revealed severe
aortic stenosis (AS). Considering the possibility of Heyde's syndrome, esophagogastroduodenoscopy was performed to confirm the presence or absence of gastrointestinal
angiodysplasia. Endoscopy revealed multiple sites of mucosal
bleeding in the stomach without
angiodysplasia or mucosal erosion. Although it was an atypical endoscopic finding, we diagnosed gastric mucosal
bleeding associated with Heyde's syndrome. Since no atypical blood vessels could be found, endoscopic treatment was not performed, and only
transcatheter aortic valve implantation (TAVI) for
aortic valve stenosis was performed. TAVI immediately improved the
dyspnea on exertion, and follow-up endoscopy 4 months after TAVI showed the disappearance of the multifocal mucosal
bleeding in the stomach. Heyde's syndrome is characterized by AS, acquired deficiency or dysfunction of
von Willebrand factor, and gastrointestinal
angiodysplasia; however, the exact diagnostic criteria have not been established. This is a case of mucosal
bleeding due to Heyde's syndrome, without the typical endoscopic image of
angiodysplasia. Cardiologists and gastroenterologists need to consider the possibility of Heyde's syndrome in AS patients with atypical gastrointestinal
bleeding on endoscopy.