Aortic stenosis
Aortic stenosis is a narrowing of the aortic valve and / or the area immediately around it.
The aorta is the main artery that takes freshly oxygenated blood from the heart to the rest of the body.
To prevent blood flowing the wrong way from the aorta back into the left ventricle, there is a valve at the exit point where the aorta meets the heart. This is the aortic valve.
Narrowing of the aortic valve is caused by a build-up of calcium on the inner wall of the valve, and tends to develop slowly as we get older.
When the components of the aortic valve thicken and harden, the valve no longer opens properly, restricting the flow of oxygenated blood out of the heart and into the aorta.
To compensate, the heart has to work harder to ensure the body receives adequate blood flow. There is also pressure build-up in the heart as it cannot expel enough blood through the aortic valve.
Initially there may not be symptoms as the heart compensates. However, as aortic stenosis progresses, patients may experience:
- chest pain or a feeling of pressure/tightening in the chest, spreading out to arms, shoulders, neck and stomach
- breathlessness during moderate to strenuous activity
- blackout during exertion when the heart is working hard.
These symptoms are identical to coronary heart disease symptoms: a cardiologist will check for aortic stenosis.
Aortic stenosis is most common in older people but some younger people born with a heart defect may also have the condition.
Diagnosis and treatment
Aortic stenosis is usually diagnosed with an echocardiogram.
It is not possible to reverse aortic stenosis through lifestyle changes, however quitting smoking, maintaining a healthy weight and eating a good diet helps to reduce strain on the heart during treatment.
Patients should seek advice from a cardiologist or doctor to determine an appropriate level of physical activity.
We cannot treat aortic stenosis with medication. If it is serious enough to require treatment, there are three options.
Surveillance
The valve may not be narrow enough to need surgery
Non-invasive valve replacement (TAVI/TAVR)
Transcatheter aortic valve implantation (TAVI)
TAVI involves inserting a catheter into a blood vessel in the upper leg or chest, and passing it towards the aortic valve.
Initial referral
Your referring consultant will write to us summarising your case, including all relevant historical information (such as test results or previous letters) for the team to review.
TAVI Clinic appointment
We will invite you to the John Radcliffe Hospital for a clinic appointment with one of our structural clinicians. You may need additional tests (which we aim to book on the same day) or further clinic appointments before progressing to the next stage.
MDT meeting
The Multidisciplinary Team (MDT) meeting is a discussion between the TAVI team and other specialist consultants, to review all your clinical information to date and make sure that there is a unanimous agreement about the best course of treatment for you.
Procedure
Once the MDT has decided on a treatment plan, we will add your name to the waiting list.
We aim to give at least two weeks' notice for procedure dates but sometimes we offer procedure dates at short notice. We will contact you by telephone to offer a procedure date, and email or post admission documents to you.
If you need more notice for your procedure date, for transport or other care needs, please contact the TAVI Coordinator:
Administrative team
First follow-up
After your procedure we invite you to the John Radcliffe Hospital for a follow-up appointment so the specialist team can check how you are getting on, and that any devices are operating correctly. You may need additional tests (which we aim to book on the same day).
After this initial follow-up appointment, if you were referred by another hospital, we will discharge you back there so that you can continue your follow-up closer to home.
Booklet
Transcatheter Aortic Valve Implantation (TAVI) (pdf|)
Referrals
Transcatheter Aortic Valve Implantation (TAVI) referrals
Valve replacement surgery
The decision to replace the valve is based on the patient's symptoms, general health, and how well their heart is working.
The procedure is typically open-heart surgery: the new valve may be made from metal or animal tissue.
Open-heart surgery is a serious procedure and patients typically need a week in hospital and two to three months off work to recover.
Links
Contact us
John Radcliffe Hospital
Oxford, OX3 9DU
Linda Dequental: 01865 223735
Email: linda.dequental@ouh.nhs.uk
Last reviewed:05 November 2024