Aortic stenosis is a valvular heart disease in which the aortic valve becomes narrowed, limiting the flow of blood from the left ventricle into the aorta. As a result, the heart must work harder to pump blood forward, which over time may lead to ventricular hypertrophy, arrhythmias, heart failure, and an increased risk of cardiac events.

 

What Is the Aortic Valve?

The aortic valve is the gateway through which oxygenated blood leaves the heart to reach the rest of the body.
When it becomes narrowed, the left ventricle must contract with greater force to overcome the obstruction — a condition that can become serious if not properly monitored and treated.

 

Main Causes

1. Degenerative (most common)

Age-related calcification of the aortic valve.

2. Congenital

• Bicuspid aortic valve, prone to early degeneration

• Rare forms associated with genetic conditions

3. Rheumatic

Less common today; a late consequence of rheumatic fever.

 

Symptoms

Aortic stenosis may remain asymptomatic for years, even when already severe.
Typical symptoms (the classic triad) include:

• Shortness of breath

• Chest pain (angina)

• Syncope or presyncope

Other symptoms: fatigue, reduced exercise capacity, palpitations, and swelling in the legs.

 

Diagnosis

Diagnosis involves clinical evaluation and imaging tests.

Cardiology Consultation

A characteristic harsh systolic murmur can often be heard.

Transthoracic Echocardiogram

The key test for assessing:

• Severity of stenosis (valve area, pressure gradients)

• Left ventricular size and function

• Presence of calcification

Additional Tests

• Transesophageal echocardiogram (in selected cases)

• Cardiac CT to quantify calcification and plan TAVI

• Exercise testing in selected patients

• Cardiac catheterization (often before surgery or TAVI)

 

Severity Levels

Aortic stenosis is typically classified as:

• Mild

• Moderate

• Severe

Severe aortic stenosis can be symptomatic or asymptomatic; in both cases, careful specialist follow-up is essential.

 

Treatment

No medication can “open” the aortic valve. Treatment is mechanical, involving valve replacement.

1. Surgical Aortic Valve Replacement (SAVR)

Indicated for:

• Symptomatic patients

• Asymptomatic patients with severe stenosis and impaired LV function

• Patients suitable for traditional cardiac surgery

Valve options:

• Biological prosthesis

• Mechanical prosthesis

2. Transcatheter Aortic Valve Implantation (TAVI)

A minimally invasive procedure performed via catheter (usually femoral access).
Indicated for:

• Elderly patients

• Patients at high surgical risk

• Increasingly considered for intermediate-risk patients based on Heart Team evaluation

3. Clinical Follow-Up

Essential for asymptomatic patients:

• Regular cardiology visits

• Echocardiogram every 6–12 months in moderate-to-severe cases

 

Prognosis

Severe symptomatic aortic stenosis carries a high risk if untreated, but modern therapies dramatically improve outcomes. Timely intervention significantly enhances symptoms, functional capacity, and quality of life.

 

When to See a Cardiologist

A specialist evaluation is recommended if you experience:

• Shortness of breath or unusual fatigue

• Chest discomfort with exertion

• Episodes of fainting

• A known heart murmur

• A family history of bicuspid aortic valve or valvular disease

 

Conclusion

Aortic stenosis is a common condition in adults and older patients.
Early diagnosis and timely treatment are key to preventing complications. Thanks to advances in surgical and transcatheter techniques, most patients today can be treated safely and effectively.