I read the article by Batur et al,1 which was accepted about a year ago by the ARCHIVES, the same journal where I published my original article in 1961.2
Fortunately, recent observations by a group in France3 have finally actually set the problem straight. As Vincentelli and coworkers3 have demonstrated, it now appears that in patients with tight aortic stenosis the huge von Willebrand factor molecule physically breaks up or functionally denatures as the blood is forced through a stenosed aortic valve, resulting in acquired von Willebrand factor deficiency syndrome. When the aortic stenosis was corrected by surgery, the functional von Willebrand defect was no longer present.
Williams RC. Aortic Stenosis and Unexplained Gastrointestinal Bleeding. Arch Intern Med. 2004;164(6):679. doi:10.1001/archinte.164.6.679-a
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