Aortic stenosis is narrowing of the aortic valve — the gateway between the left ventricle and the rest of the body. As the valve calcifies and stiffens, the heart has to work harder to push blood through the narrowed opening. Severe aortic stenosis is one of the more common valve problems in older Australians.
Symptoms
- Breathlessness on exertion
- Chest tightness or angina
- Dizziness or fainting (syncope)
- Reduced exercise tolerance
Symptoms often develop gradually and are sometimes attributed to ageing. Once symptoms appear in severe aortic stenosis, the natural history without treatment is unfavourable, which is why timely review matters.
Diagnosis
An echocardiogram (heart ultrasound) is the primary diagnostic test. Severity is graded by valve area, mean gradient, and peak velocity. CT and exercise testing are sometimes used to clarify borderline cases or to plan intervention.
Treatment options
Asymptomatic mild-to-moderate disease is monitored with periodic echocardiograms. For severe symptomatic aortic stenosis, the two main treatments are:
- Transcatheter aortic valve implantation (TAVI) — a less invasive procedure where a new valve is delivered through a leg artery
- Surgical aortic valve replacement (SAVR) — open-heart surgery
Choice between TAVI and surgery depends on age, anatomy, surgical risk, and patient preference. This decision is made jointly with a cardiothoracic surgeon at a Heart Team meeting.