Our understanding of the deleterious effects of chest wall irradiation therapy (C-XRT) on the cardiovascular system has evolved since the first report of myocardial cell damage back in 1929, to the current-day recognition of a heterogenous disease that can involve the coronary arteries, myocardium, pericardium, conduction system and heart valves [ , ]. Radiation-induced aortic valvulopathy is a well-defined pathology within radiation-induced heart disease (RIHD), with aortic stenosis (AS) being the most common lesion requiring correction [ ]. The challenge, however, lies in the choice of intervention for severe AS in this understudied population.