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Background Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce. Methods 2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde). Results A history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05). Conclusion A relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS. Graphic abstract

After muscular or periostal bleedings hemophilic pseudo tumors can occur as a complication of inadequate replacement therapy in hemophiliacs. They are incomplete reabsorbed and encapsulated hematomas that show recurrent bleeding inside a pseudocyst together with progressive growth and that mimic malign tumors. The disease was first described by Starker in 1918 [1]; Fernandez de Valderrama [2] demonstrated the detailed pathomechanism and recognized the importance of vascularization of hemophilic pseudo tumors [3]. Due to their progredient growth and depending on their anatomical location hemophilic pseudo tumors produce clinical symptoms as a result of soft tissue destruction, bone erosion or neurovascular compression.

Magnetic resonance imaging (MRI) enables exact evaluation of synovial and cartilaginous structures of the joints. In contrast, conventional radiology describes changes in bony structures, cartilage is not visualized. Bony defects, however, represent irreversible, long-term damage due to recurrent bleeding into hemophilic joints. MRI thus is the Method of choice for early diagnosis of beginning joint damage with the opportunity to start therapeutical interventions in time.

Characteristics of hemophilic arthropathy are recurrent bleedings, chronic synovitis and osteochondral destruction. Prophylactic treatment to prevent intraarticular bleeding is essential. If chronic arthritis has already occurred, operative treatment is considered. Alternatively radiosynoviorthesis (RSO) is discussed. We investigated the effect of outpatient treatment with RSO on advanced hemophilic arthropathic joints.

A total of 119 patients (January 1995-December 1996; 53 women, 66 men) with a medium age of 63.1 years were admitted to hospital with bleeding gastroduodenal ulcer. Emergency gastroduodenoscopy was performed immediately in all cases, sclerotherapy in 94 cases (78.9%). Control endoscopy was done routineiy after 12–24 h; the recurrent bleeding rate amounted to 14.3%, mortality was 5%, and surgical Intervention was necessary in 8.4% with a mortality of 40% (!).

Juvenile nasopharyngeal angiofibromas frequently require surgery of the paranasal sinuses as well as of the sellar region. This demands a close interdisciplinary cooperation before, during, and after the intervention (Samii and Draf 1989). The symptoms depend on the size of the tumor. Nasal obstruction, nasal speech, cheek swelling, dislocation of orbital contents, recurrent middle ear effusions, and headache have been the most frequent ones in our seven fairly extended cases, operated on over the past 5 years. Recurrent bleeding occurred less commonly, as one might expect. In only one case was a cranial nerve deficit, namely a deterioration of vision, observed. This recovered completely following optic nerve decompression after microsurgical tumor removal. In three cases intracranial extension was obvious.

In contrast to aneurysms with subarachnoid hemorrhage or intracerebral hematomas, the timing of surgery in cases of large aneurysms is not primarily dependent on the rupture or the danger of recurrent bleeding. Giant aneurysms are defined as aneurysms with a diameter of more than 2.5 cm according to MORLEY (12). Normally these aneurysms do not attract attention because of a rupture but because they lead to signs of a space-occupying lesions and brain compression (9, 18).

Besides recurrent bleeding, cerebral vasospasm is a major complicating factor after subarachnoid hemorrhage (SAH) from cerebral aneurysm (20,21,33).

The number of cerebro-spinal vascular anomalies has increased in the last decade due to improved knowledge of their presenting symptoms and the early use of angiography especially in cases complicated by acute hemorrhage. Our own material (Table 1) now comprises 272 a.v.-angiomas; 56 were extracerebral, 124 cerebral, and 92 spinal.

Good operative results on aneurysms one to three weeks after subarachnoid hemorrhage with a mortality of under 5% (PIA 1969) have to be paid for with high mortality rates due to recurrent bleeding and vasospasm during the waiting period. Mortality with this type of management (ADAMS 1981, HUNT 1980, WEIR 1981) can be as high as 42% (KASSELL 1981). Results with early operations within two to three days published up to now are more favorable, although the operative mortality is about 10% (HUGENHOLTZ 1982, HORI and SUZUKI 1979, HUNT 1980, KASSELL 1981, KOBAYASHI 1979, LJUNGGREN 1981, SANO 1978, TAKAHASHI 1979, WEIR 1981). This is explained by earlier suppression of the risk of rebleeding as well as reduction of complications related to vasospasm, due to removal of clots from the subarachnoid space.

In an unselected series of cases at the University Neurosurgical Clinic of Gottingen we have seen 56 angioma cases, 20 of which were located in or near the midline of the brain.