16 July 2026
: Case report 
Heyde Syndrome Complicated by Pulmonary Embolism Before Transcatheter Aortic Valve Replacement: A Clinical Dilemma Between Bleeding and Thrombosis
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Mingying Cao ACEF 1*, Lingli Zhang BEF 1, Ying Ren BF 1, Gejun Zhang
ADF 2
DOI: 10.12659/AJCR.953608
Am J Case Rep 2026; 27:e953608
Table 1 Diagnosis and treatment timeline.
| Time point | Clinical manifestation | Treatment and key findings |
|---|---|---|
| 4 days before admission | Hematochezia | Patient ignored symptoms |
| 1 day before admission | Fatigue | Emergency blood transfusion; emergency gastroscopy and colonoscopy performed |
| Hospital day 1 | Sudden onset of dyspnea and wheezing; Suspected heart failure | Admitted to CCU; blood transfusion and cardiac function support initiated; physical examination revealed aortic valve murmur |
| Hospital day 2 | — | Cardiac ultrasound confirmed severe aortic valve stenosis |
| Hospital day 3 | — | von Willebrand Factor analysis: vWF antigen 38.5% (reference: 50%–160%); vWF Activity (RCo) 25.3% (reference: 48.8–163.4%) |
| Hospital day 10 | Hematochezia resolved; Hemoglobin rebounded; General condition improved | Incidental finding of acute pulmonary embolism on coronary CTA; anticoagulation initiated; TAVR planned |
| Hospital day 16 | Patient discharged | |
| Before second hospitalization (37 days after previous hospitalization) | — | Pulmonary artery CTA showed complete resolution of pulmonary embolism |
| TAVR performed (50 days after previous hospitalization) | — | TAVR performed under general anesthesia |
| First follow-up (19 days after TAVR) | No hematochezia recurrence; Good cardiac function | Aortic valve flow velocity: 239 cm/s; LVEF = 62% |
| Second follow-up (63 days after TAVR; 4 months after initial hospitalization) | No hematochezia recurrence; good cardiac function | Aortic valve flow velocity: 110 cm/s; LVEF = 61% |
| Abbreviations: CCU, coronary care unit; CTA, computed tomography angiography; LVEF, left ventricular ejection fraction; RCo, ristocetin cofactor; TAVR, transcatheter aortic valve replacement; vWF, von Willebrand factor. | ||