Aortic Stenosis
Aortic stenosis is narrowing of the aortic valve that obstructs blood flow from the left ventricle. In older adults it is usually caused by progressive calcific degeneration of a tricuspid or bicuspid valve; less common causes include rheumatic and congenital valve disease.
The heart must pump against rising resistance and the muscle thickens. Untreated, this can progress to heart failure, arrhythmia and sudden cardiac events.
Clinical features
Symptoms typically include breathlessness, chest pain, fainting or reduced exercise tolerance, often first detected as a heart murmur on examination. Older patients may present atypically with fatigue or falls, and new or worsening symptoms warrant urgent evaluation.
Diagnosis and assessment
Echocardiography is the key diagnostic test, assessing valve severity alongside heart function. Referral to a cardiologist or valve clinic is recommended when aortic stenosis is moderate-to-severe, symptomatic, or when heart function is declining.
Treatment options
Surgical aortic valve replacement (SAVR) is open-heart surgery to implant a mechanical or bioprosthetic valve. It remains the preferred option for younger patients and those with anatomy unsuited to a catheter-based approach.
Transcatheter aortic valve implantation (TAVI) is a minimally invasive alternative performed via catheter, without open-heart surgery — see our TAVI page for more detail.
The right choice depends on age, surgical risk, valve and vascular anatomy, and patient preferences, and is made by a multidisciplinary heart team in partnership with the patient.
