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Article

Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves

1
Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
2
Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
3
Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
4
Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
*
Author to whom correspondence should be addressed.
J. Cardiovasc. Dev. Dis. 2021, 8(7), 79; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070079
Received: 22 May 2021 / Revised: 29 June 2021 / Accepted: 5 July 2021 / Published: 8 July 2021
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 (n = 31) from patients with aortic stenosis (n = 17) or aortic regurgitation due to aortic dilatation (n = 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. View Full-Text
Keywords: aortic stenosis; aortic regurgitation; superimposed tissue; original leaflet; myofibroblasts; free edge folding aortic stenosis; aortic regurgitation; superimposed tissue; original leaflet; myofibroblasts; free edge folding
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MDPI and ACS Style

Kruithof, B.P.T.; van Wijngaarden, A.L.; Mousavi Gourabi, B.; Hjortnaes, J.; Palmen, M.; Ajmone Marsan, N. Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves. J. Cardiovasc. Dev. Dis. 2021, 8, 79. https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070079

AMA Style

Kruithof BPT, van Wijngaarden AL, Mousavi Gourabi B, Hjortnaes J, Palmen M, Ajmone Marsan N. Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves. Journal of Cardiovascular Development and Disease. 2021; 8(7):79. https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070079

Chicago/Turabian Style

Kruithof, Boudewijn P.T., Aniek L. van Wijngaarden, Babak Mousavi Gourabi, Jesper Hjortnaes, Meindert Palmen, and Nina Ajmone Marsan. 2021. "Superimposed Tissue Formation in Human Aortic Valve Disease: Differences between Regurgitant and Stenotic Valves" Journal of Cardiovascular Development and Disease 8, no. 7: 79. https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070079

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