The association between AVMs and aortic stenosis, for many years known as Heyde syndrome, has been discredited over the last decade, in part due to a lack of objective criteria to define the valvular and gastrointestinal findings. Given our recent study,1 which showed that both severe and overall aortic stenosis rates were higher in patients with AVMs, it is appropriate to renew interest in this association. We agree with the comments in Dr Rogers' letter that further studies are critical to understanding the mechanisms between cardiovascular disease and gastrointestinal bleeding. Is the bleeding caused by atherosclerotic disease, or a specific valvular phenomenon? If the etiology is based on valvular stenosis, is it specific to the aortic valve? Our study showed much lower rates of mitral stenosis in patients with AVMs, and we were not able to evaluate any potential causes for this association. With multiple reports suggesting that valvular aortic stenosis may be caused by the same pathways as atherosclerosis,2,3 further studies are needed to determine whether AVMs are related to an atherosclerotic-like process, with or without ischemia.
Batur P, Stewart WJ, Isaacson JH. Aortic Stenosis and Unexplained Gastrointestinal Bleeding—Reply. Arch Intern Med. 2004;164(6):679. doi:10.1001/archinte.164.6.679-b