Aortic stenosis, the 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. This condition develops slowly and silently, often first detected as a murmur, until symptoms like breathlessness, chest tightness, dizziness, or fainting emerge. At this stage, timing becomes crucial—severe symptomatic aortic stenosis can lead to serious complications without treatment, but when managed appropriately, outcomes are excellent.
As a Consultant Interventional and Structural Cardiologist based in London and Essex, I specialize in aortic stenosis and heart valve replacement techniques, particularly TAVI (transcatheter aortic valve implantation), which allows for keyhole valve replacement without the need for open-heart surgery. I oversee the complete patient pathway—starting from the initial murmur or diagnosis, through detailed assessment and monitoring, to timely valve intervention.
Aortic stenosis often remains silent for years. The classic warning symptoms include:
- Breathlessness on exertion — usually the first symptom, easily mistaken for aging or lack of fitness
- Chest tightness or pressure during activity
- Dizziness or light-headedness, particularly when exerting yourself
- Fainting (syncope) — a red-flag symptom that requires urgent assessment
- Fatigue and a gradual, often unnoticed decrease in what you can do
Many patients with aortic stenosis adapt unconsciously by walking more slowly and avoiding hills and stairs, which can lead to missed symptoms. A pertinent question to consider is: what could you do one or two years ago that you cannot do now? If symptoms become severe, heart valve replacement or TAVI may be necessary options to discuss with a healthcare provider.
While aortic stenosis is often asymptomatic, the risk of delaying intervention is low, and monitoring the condition is generally considered safe. However, once symptoms arise in cases of severe aortic stenosis, the prognosis changes dramatically—historically, average survival without treatment has been just a few years. This reality is often not fully understood, even among patients who have merely been advised that they have a 'heart murmur to keep an eye on.'
Equally significant is the fact that heart valve replacement significantly enhances the prognosis, improving both life expectancy and quality of life for the majority of patients. The role of specialist care lies in precise grading of the condition, diligent follow-up, and timely intervention—ensuring procedures such as TAVI are performed neither too early nor too late.
My research focuses on addressing this critical challenge, including studies aimed at the detection and timely treatment of severe aortic stenosis. This evidence directly informs my approach to monitoring and treating my patients.
Your first appointment lasts around 30 minutes and includes:
A detailed symptom assessment — including the subtle symptoms of aortic stenosis that patients often discount.
A review of any previous echocardiograms and the rate of progression of your heart valve narrowing.
A physical examination — the murmur associated with aortic stenosis has characteristic features.
A clear plan — precise grading of your stenosis, a monitoring schedule if heart valve replacement isn't yet needed, or prompt work-up if TAVI is required.
An echocardiogram serves as the cornerstone test for assessing aortic stenosis, measuring the valve area, the pressure across the valve, and the heart muscle's response. Serial scans are essential for tracking the progression of heart valve issues. A CT scan of the aortic valve quantifies valve calcium, aiding in cases where the severity of stenosis is uncertain. This scan also provides detailed measurements that are critical for planning TAVI procedures. Exercise testing proves valuable, particularly when patients report no symptoms, as it can objectively reveal limitations and help determine the timing for heart valve replacement. Blood tests, including NT-proBNP, a marker of heart strain, further assist in refining timing decisions for interventions. Finally, coronary angiography is performed to check the heart's arteries before any valve intervention, and I personally oversee this important step.
Mild and moderate aortic stenosis is monitored with scheduled echocardiograms—typically every one to three years depending on severity and progression rate. While no medication slows the narrowing of the heart valve, managing blood pressure and cholesterol helps protect your heart overall.
Severe symptomatic aortic stenosis requires a heart 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. 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 has become the most common form of aortic valve replacement in many countries.
Surgical aortic valve replacement (SAVR) — open-heart surgery remains the preferred option for some patients, particularly younger individuals or those needing other cardiac procedures simultaneously.
The right choice for heart valve replacement depends on your age, anatomy, other health conditions, and personal preferences. Every case is discussed at a specialist Heart Team meeting—comprising both cardiologists and cardiac surgeons—and I will openly explain the reasoning behind the recommendation, including the evidence applicable to your specific situation.
This is my subspecialty — Consultant Interventional and Structural Cardiologist with dedicated expertise in aortic stenosis and heart valve replacement through TAVI. I perform transcatheter valve procedures at leading centres. I am research-active in this exact field with a PhD from King's College London, an advanced structural intervention fellowship at San Raffaele Hospital in Milan, and over 100 peer-reviewed publications, including significant research on the detection and timely treatment of severe aortic stenosis. I provide a complete pathway under one consultant — from murmur assessment and monitoring through work-up, TAVI, and follow-up, ensuring there is no fragmentation of care. I offer rapid access with same-week appointments at Heart Health Welbeck London (Marylebone), Cromwell Hospital (Kensington), The Wellington Hospital (St John's Wood), Bupa Health Care Canary Wharf, and The Essex Cardiothoracic Centre (Basildon). Consultations are available in English and Turkish, and I am recognized by all major private medical insurers; self-paying patients are also welcome.
In cases of aortic stenosis, timing is crucial — expert assessment allows for heart valve replacement or TAVI at the optimal moment, rather than waiting for symptoms to escalate. Contact my practice team to arrange a consultation at one of my London or Essex locations.
To schedule a consultation, reach out to Ms. Melinda Ziff (PA) at 020 3198 9826 or drozandemir.sec@outlook.com.