Aortic stenosis is found in 15 to 25% of patients with gastrointestinal
angiodysplasia. The usual treatment for haemorrhagic
angiodysplasia associated with
aortic stenosis is the same as for other types of gastrointestinal
angiodysplasias: segmental intestinal resection,
electrocoagulation and
laser photocoagulation. The authors report the case of a 73 year old woman with a long history of gastro-intestinal
bleeding and chronic anaemia requiring a number of hospital admissions for
blood transfusions. The cause of this
bleeding remained obscure for many years, as it was initially thought to be due to
portal hypertension complicating cyrrhosis and a surgical porto-caval shunt was performed. Later,
angiodysplasia of the colon was recognised and a segmental colonic resection was performed. These two
surgical procedures had no effect on the chronic
bleeding and finally the patient was referred for a gram negative
endocarditis complicating
aortic stenosis, previously considered to be non-surgical. After controlling the
infection, the patient was sent for surgery of the
aortic valve disease with
mitral regurgitation in view of progressive degradation of left ventricular function. A double valve replacement with
bioprostheses was undertaken with no complication. Finally, three years now after valve replacement, no further
bleeding has occurred and control colonoscopy is normal. In the light of this case and a review of the literature of about 30 similar cases, the physiopathology and management of these patients is discussed with respect to the choice of valve
prosthesis and the attitude to
anticoagulant therapy. These observations suggest that in the presence of
valvular heart disease at a surgical stage associated to an
angiodysplasia, it is preferable to propose valve surgery to start with. Gastro-intestinal surgery is only indicated if haemorrhage persists after a period of observation.