Aortic Stenosis

Aortic stenosis — narrowing of the heart's main outflow valve — is the most common serious heart valve condition, affecting around 1 in 8 people over the age of 75. It develops slowly and silently, often first noticed as a murmur, until symptoms appear: breathlessness, chest tightness, dizziness or fainting. From that point, timing matters — severe symptomatic aortic stenosis carries a serious outlook without treatment, yet treated properly, outcomes are excellent.

This condition is the centre of my specialist practice. I am a Consultant Interventional and Structural Cardiologist in London and Essex, with subspecialty expertise in aortic stenosis and TAVI (transcatheter aortic valve implantation) — keyhole valve replacement without open-heart surgery. I manage the complete pathway: from first murmur or diagnosis, through precise assessment and monitoring, to valve intervention at the right time.

Aortic stenosis is often silent for years. The classic warning symptoms are:

• Breathlessness on exertion — usually the first symptom, and easily mistaken for ageing or lack of fitness
• Chest tightness or pressure on activity
• Dizziness or light-headedness, particularly on exertion
• Fainting (syncope) — a red-flag symptom requiring urgent assessment
• Fatigue and a gradual, often unnoticed reduction in what you can do

Many patients adapt unconsciously — walking more slowly, avoiding hills and stairs — so symptoms are missed. A useful question: what could you do one or two years ago that you cannot do now?

While aortic stenosis is asymptomatic, the risk of waiting is low and monitoring is safe. But once symptoms develop in severe stenosis, the outlook changes sharply — historically, average survival without treatment is measured in a small number of years, This is not widely appreciated, even among patients told they have a "heart murmur to keep an eye on".

The corollary is equally important: valve replacement transforms the outlook, restoring both life expectancy and quality of life in the great majority of patients. The task of specialist care is precise grading, vigilant follow-up, and intervening at the right moment — neither too early nor too late.

My research work focuses on exactly this challenge — including studies on the detection and timely treatment of severe aortic stenosis — and this evidence base directly informs how I monitor and treat my patients.

Your first appointment lasts around 30 minutes and includes:

1. A detailed symptom assessment — including the subtle, adapted-to symptoms patients often discount
2. A review of any previous echocardiograms and the rate of progression of your valve narrowing
3. A physical examination — the murmur of aortic stenosis has characteristic features
4. A clear plan — precise grading of your stenosis, a monitoring schedule if intervention isn't yet needed, or prompt work-up if it is

• Echocardiogram — the cornerstone test, measuring the valve area, the pressure across the valve and the heart muscle's response. Serial scans track progression
• CT scan of the aortic valve — quantifies valve calcium (helpful when severity is uncertain) and provides the detailed measurements used to plan TAVI
• Exercise testing — valuable when patients report no symptoms; it can objectively unmask limitation and guide timing
• Blood tests — including NT-proBNP, a marker of heart strain that helps refine timing decisions
• Coronary angiography — checking the heart's arteries before any valve intervention, performed by me personally

Mild and moderate stenosis is monitored with scheduled echocardiograms — typically every one to three years depending on severity and progression rate. No medication slows the valve narrowing itself, but managing blood pressure and cholesterol protects your heart overall.

Severe symptomatic stenosis needs valve replacement. There are two established approaches:

• TAVI (transcatheter aortic valve implantation) — my subspecialty. A new valve is delivered through a small puncture in the groin artery and implanted inside the narrowed valve, on a beating heart, without opening the chest. The procedure typically takes around an hour, usually under local anaesthetic with sedation, and most patients are home within a day or two — with symptom improvement often noticeable almost immediately. Once reserved for patients too frail for surgery, TAVI is now a guideline-recommended option across a broad range of patients, and in many countries has become the most common form of aortic valve replacement.

• Surgical aortic valve replacement (SAVR) — open-heart surgery remains the preferred option for some patients, particularly younger patients or those needing other cardiac surgery at the same time.

• The right choice depends on your age, anatomy, other health conditions and preferences. Every case is discussed at a specialist Heart Team meeting — cardiologists and cardiac surgeons together — and I will explain the reasoning behind the recommendation openly, including the evidence for your specific situation.

• This is my subspecialty — Consultant Interventional and Structural Cardiologist with dedicated expertise in aortic stenosis and TAVI, performing transcatheter valve procedures at leading centres
• Research-active in this exact field — PhD from King's College London, advanced structural intervention fellowship at San Raffaele Hospital, Milan, and over 100 peer-reviewed publications, including research on the detection and timely treatment of severe aortic stenosis
• The complete pathway under one consultant — from murmur assessment and monitoring through work-up, TAVI and follow-up, with no fragmentation of care
• Rapid access — same-week appointments at Heart Health Welbeck London (Marylebone), Cromwell Hospital (Kensington), The Wellington Hospital (St John's Wood), Bupa Health Care Canary Wharf, The Essex Cardiothoracic Centre (Basildon)
• Consultations in English and Turkish
• Recognised by all major private medical insurers; self-paying patients welcome

In aortic stenosis, timing is everything — expert assessment now means treatment at the right moment, not after symptoms have taken their toll. Contact my practice team to arrange a consultation at one of my London or Essex locations.

Contact Ms Amelia Garner (PA) on 020 3198 9826 or drozandemir.sec@outlook.com to arrange a consultation.