Aortic stenosis

What is aortic stenosis?

Aortic artery stenosis occurs when there is a narrowing of the aortic valve in your heart. The aortic valve is one of four heart valves and connects the left side of the heart to your aorta, the large artery that carries blood to the body. It opens to let the blood flow through and closes again to prevent blood from flowing back to the heart. 

In aortic stenosis, the narrowing means the aortic valve is unable to open as fully as it should. This puts the heart under increasing strain as it has to deliver the same out of blood through a smaller and smaller exit. If left untreated it can lead to serious complications including death.

As a result of the narrowing in the valve, pressure inside the chamber is increased and your heart has to work harder to pump blood through, which can eventually lead to a weakened heart muscle and other symptoms related to aortic stenosis.

If you're concerned about your symptoms, our specialist team can provide the most effective care and treatment, tailored to you. 

How serious is aortic stenosis? 

Over time, and if not treated, aortic stenosis can lead to serious health problems such as heart failure, stroke, blood clots and even death. That's why it's important to see a healthcare provider if you think you might be experiencing aortic stenosis. 

With the right diagnosis and treatment, the complications and risks associated with the condition can be reduced or eliminated. 

What are the causes of aortic stenosis? 

There are a variety of factors that can lead to aortic stenosis with the main causes being: 

• Congenital defect: This is the main cause of aortic valve stenosis in children where the heart issue develops while in the womb. While there isn't one clear cause of congenital defects, there might be an increased risk if there is a family history or if the mother suffered from a condition such as diabetes when pregnant.
• Age: A calcium build-up, which happens over time, can result in narrowing of the valve. This is commonly due to the ageing process and occurs most often in those over the age of 65.
• Infection: Sometimes, being exposed to certain infections that have been left untreated can cause damage. Such infections include strep throat and scarlet fever, which can then lead to rheumatic fever. 
• Other conditions: There is also a link between aortic stenosis and autoimmune conditions such as rheumatoid arthritis and rheumatic fever.

Risk factors associated with aortic stenosis 

Like with many other heart conditions, risk factors for developing aortic valve stenosis include: 

• Being a smoker: According to the British Heart Foundation, over 15,000 deaths from heart and circulatory disease every year are linked to smoking
• Having high blood pressure
• High cholesterol 
• Radiation therapy on the chest 

How is aortic stenosis diagnosed? 

An early diagnosis of aortic stenosis is key to getting the most appropriate treatment. If you have been displaying symptoms associated with the condition, your consultant may carry out a physical examination to assess any obvious signs of aortic stenosis. This will likely include using a stethoscope to check if you have a heart murmur, which can be an indicator of the condition. 

Other diagnostic tests may include:

• Echocardiogram: This is the main test that diagnoses aortic stenosis and is also used to monitor its progression. Using ultrasound waves, this scan gives an accurate picture of the valve and shows the flow of blood across the valve. It’s also used to calculate the area of the opening of the valve. 
• Cardiac MRI: This detailed scan shows the heart's structure in detail and can help in the diagnosis of aortic stenosis. It can also show if there is any scarring of the heart due to a problem with the valve. You might need to have dye injected into your veins to produce the clearest images.
• Chest X-ray: As well as showing the health of the heart and lungs, a chest X-ray can identify any abnormal swelling or calcium build-up. 
• Echocardiogram: This scan shows how well your heart and valves are working using ultrasound. It can highlight any areas of damage or narrowing of the arteries. There are two types of echocardiogram, a transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE). While a TTE is an ultrasound that’s performed using a transducer on the chest, a TOE is swallowed and is placed in the oesophagus to get a clearer image with less interference. You might be offered either or both of these tests, depending on your individual condition.  
• Electrocardiogram (ECG): This test is used to diagnose an abnormal heartbeat and can detect if your heart is under significant strain from the narrowed valve. It involves attaching sensors to your chest, wrists and ankles which are connected to a machine that records the signals. This can help diagnose an arrhythmia and is often carried out as part of a routine examination.
• Exercise tests or stress tests: You might be asked to run or walk on a treadmill while images of your heart are taken via electrodes on the chest. This test is often used in cases where it’s not easy to assess how severe the disease. Sometimes, instead of walking or cycling, the test can be done by injecting drugs into a vein to stress the heart.

If you have signs of aortic stenosis, rest assured we'll use a combination of diagnostic techniques to get a clear picture of your condition which will inform the most effective treatment for you.

Aortic valve stenosis treatment 

As with many cardiac conditions, treatment options for aortic stenosis very much depend on the severity of the condition. 

If your symptoms remain mild and pose no great risk to your immediate health, your consultant may recommend healthy lifestyle changes relating to diet and exercise. They may also provide you with medication to minimise risk of further complications.

Aortic stenosis medication 

If your treatment plan for aortic stenosis includes medication, you might be prescribed drugs that have an effect on the rhythm of the heart such as: 

• Beta blockers: If chest pain (angina) is a concern, beta-blockers can help lower your heart rate and blood pressure, reducing angina episodes 
• ACE inhibitors: Angiotensin-converting enzyme (ACE) inhibitors help manage high blood pressure, a common condition that can worsen aortic stenosis
• Diuretics: In cases of heart failure due to aortic stenosis, diuretics may be used to eliminate excess fluid buildup

Aortic stenosis surgery

In many cases, surgery is often the preferred treatment choice for aortic stenosis and involves repairing or replacing the valve to restore proper function to the heart. Your consultant will take into account a variety of factors when determining which is the best course of action.

If surgery is the most effective treatment option for you, it might be recommended that you have one of the following: 

Aortic valve replacement

This can be carried out as open-heart surgery or as a less invasive procedure, via small incisions in the chest. The surgery you have will depend on multiple factors such as the extent of the damage and your overall health. You'll be connected to a machine that will take over the work of your heart and lungs while you're having the procedure.  

Your heart will be stopped to allow it to be opened. The valve is removed and replaced with a new valve. There are several types of valve replacement available and your surgeon will explain the most appropriate one for you.

TAVI (transcatheter aortic valve implantation)

A transcatheter aortic valve implantation (TAVI) procedure is minimally invasive and is an alternative to open-heart surgery. A thin, flexible tube is inserted through the skin, normally in the groin, and a catheter is passed towards the heart and through the opening of the narrowed aortic valve. A small balloon is sometimes used to expand the aortic valve. 

This procedure is usually carried out under local anaesthetic with mild sedation and takes around two hours to complete. 

Balloon valvuloplasty

This is a minimally invasive procedure that involves placing a catheter in the heart valve via an artery in the groin. It's often the chosen procedure for children with congenital aortic stenosis. A deflated balloon is attached to the catheter which is inflated in the valve to increase the opening. Like a TAVI procedure, this is usually carried out under local anaesthetic.

While balloon valvuloplasty is not an alternative to other types of aortic valve stenosis surgery, it can be the most effective treatment in some cases. 

Are there any risks of aortic stenosis surgery? 

Risks of aortic stenosis operations can vary and individual risks will depend on the nature of the condition and any other health concerns. Your consultant will explain these to you before your procedure but it's important to be aware that, if you've been recommended surgery, then the benefits will outweigh the risks.  

Risks of any type of heart surgery can include: 

• Death, however, the risk of this is very small
• Heart attack
• Bleeding
• Arrhythmia 
• Small risk of stroke
• The need for further aortic valve stenosis surgery

It's important to remember that minimally invasive procedures typically carry less risk than more serious surgeries such as open-heart surgery.

What is the success rate of aortic valve stenosis surgery

The vast majority of procedures are extremely successful and people are typically able to live a better quality of life and enjoy a greater life-expectancy afterwards. The overall survival rate of our Isolated Aortic Valve Replacement surgeries is 99.5% (from 2021 - 2023).

Personalising your treatment

The decision as to whether to intervene or not is often complex and, in addition, whether you should have conventional surgery or a TAVI procedure depends on multiple factors. Your surgeon or cardiologist will frequently take your case to a large multi-disciplinary meeting where multiple clinicians will be present. Your case will be presented and discussed and a recommendation made specifically for you.