Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves
The formation of superimposed tissue (SIT), a layer on top of the original valve leaflet, has been described in patients with mitral regurgitation as a major contributor to valve thickening and possibly as a result of increased mechanical stresses. However, little is known whether SIT formation also...
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doaj-f990fac65eeb46e3a1e60da67dc941772021-07-23T13:47:41ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252021-07-018797910.3390/jcdd8070079Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic ValvesBoudewijn P. T. Kruithof0Aniek L. van Wijngaarden1Babak Mousavi Gourabi2Jesper Hjortnaes3Meindert Palmen4Nina Ajmone Marsan5Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsThe formation of superimposed tissue (SIT), a layer on top of the original valve leaflet, has been described in patients with mitral regurgitation as a major contributor to valve thickening and possibly as a result of increased mechanical stresses. However, little is known whether SIT formation also occurs in aortic valve disease. We therefore performed histological analyses to assess SIT formation in aortic valve leaflets (<i>n</i> = 31) from patients with aortic stenosis (<i>n</i> = 17) or aortic regurgitation due to aortic dilatation (<i>n</i> = 14). SIT was observed in both stenotic and regurgitant aortic valves, both on the ventricular and aortic sides, but with significant differences in distribution and composition. Regurgitant aortic valves showed more SIT formation in the free edge, leading to a thicker leaflet at that level, while stenotic aortic valves showed relatively more SIT formation on the aortic side of the body part of the leaflet. SIT appeared to be a highly active area, as determined by large populations of myofibroblasts, with varied extracellular matrix composition (higher collagen content in stenotic valves). Further, the identification of the SIT revealed the presence of foldings of the free edge in the diseased aortic valves. Insights into SIT regulation may further help in understanding the pathophysiology of aortic valve disease and potentially lead to the development of new therapeutic treatments.https://www.mdpi.com/2308-3425/8/7/79aortic stenosisaortic regurgitationsuperimposed tissueoriginal leafletmyofibroblastsfree edge folding |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Boudewijn P. T. Kruithof Aniek L. van Wijngaarden Babak Mousavi Gourabi Jesper Hjortnaes Meindert Palmen Nina Ajmone Marsan |
spellingShingle |
Boudewijn P. T. Kruithof Aniek L. van Wijngaarden Babak Mousavi Gourabi Jesper Hjortnaes Meindert Palmen Nina Ajmone Marsan Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves Journal of Cardiovascular Development and Disease aortic stenosis aortic regurgitation superimposed tissue original leaflet myofibroblasts free edge folding |
author_facet |
Boudewijn P. T. Kruithof Aniek L. van Wijngaarden Babak Mousavi Gourabi Jesper Hjortnaes Meindert Palmen Nina Ajmone Marsan |
author_sort |
Boudewijn P. T. Kruithof |
title |
Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves |
title_short |
Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves |
title_full |
Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves |
title_fullStr |
Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves |
title_full_unstemmed |
Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves |
title_sort |
superimposed tissue formation in human aortic valve disease: differences between regurgitant and stenotic valves |
publisher |
MDPI AG |
series |
Journal of Cardiovascular Development and Disease |
issn |
2308-3425 |
publishDate |
2021-07-01 |
description |
The formation of superimposed tissue (SIT), a layer on top of the original valve leaflet, has been described in patients with mitral regurgitation as a major contributor to valve thickening and possibly as a result of increased mechanical stresses. However, little is known whether SIT formation also occurs in aortic valve disease. We therefore performed histological analyses to assess SIT formation in aortic valve leaflets (<i>n</i> = 31) from patients with aortic stenosis (<i>n</i> = 17) or aortic regurgitation due to aortic dilatation (<i>n</i> = 14). SIT was observed in both stenotic and regurgitant aortic valves, both on the ventricular and aortic sides, but with significant differences in distribution and composition. Regurgitant aortic valves showed more SIT formation in the free edge, leading to a thicker leaflet at that level, while stenotic aortic valves showed relatively more SIT formation on the aortic side of the body part of the leaflet. SIT appeared to be a highly active area, as determined by large populations of myofibroblasts, with varied extracellular matrix composition (higher collagen content in stenotic valves). Further, the identification of the SIT revealed the presence of foldings of the free edge in the diseased aortic valves. Insights into SIT regulation may further help in understanding the pathophysiology of aortic valve disease and potentially lead to the development of new therapeutic treatments. |
topic |
aortic stenosis aortic regurgitation superimposed tissue original leaflet myofibroblasts free edge folding |
url |
https://www.mdpi.com/2308-3425/8/7/79 |
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