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Mitral valve disease--morphology and mechanisms
#MMPMID26483167
Levine RA
; Hagége AA
; Judge DP
; Padala M
; Dal-Bianco JP
; Aikawa E
; Beaudoin J
; Bischoff J
; Bouatia-Naji N
; Bruneval P
; Butcher JT
; Carpentier A
; Chaput M
; Chester AH
; Clusel C
; Delling FN
; Dietz HC
; Dina C
; Durst R
; Fernandez-Friera L
; Handschumacher MD
; Jensen MO
; Jeunemaitre XP
; Le Marec H
; Le Tourneau T
; Markwald RR
; Mérot J
; Messas E
; Milan DP
; Neri T
; Norris RA
; Peal D
; Perrocheau M
; Probst V
; Pucéat M
; Rosenthal N
; Solis J
; Schott JJ
; Schwammenthal E
; Slaugenhaupt SA
; Song JK
; Yacoub MH
Nat Rev Cardiol
2015[Dec]; 12
(12
): 689-710
PMID26483167
show ga
Mitral valve disease is a frequent cause of heart failure and death. Emerging
evidence indicates that the mitral valve is not a passive structure, but--even in
adult life--remains dynamic and accessible for treatment. This concept motivates
efforts to reduce the clinical progression of mitral valve disease through early
detection and modification of underlying mechanisms. Discoveries of genetic
mutations causing mitral valve elongation and prolapse have revealed that growth
factor signalling and cell migration pathways are regulated by structural
molecules in ways that can be modified to limit progression from developmental
defects to valve degeneration with clinical complications. Mitral valve
enlargement can determine left ventricular outflow tract obstruction in
hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable
biological valvular-ventricular interactions. Mitral valve plasticity also allows
adaptive growth in response to ventricular remodelling. However, adverse cellular
and mechanobiological processes create relative leaflet deficiency in the
ischaemic setting, leading to mitral regurgitation with increased heart failure
and mortality. Our approach, which bridges clinicians and basic scientists,
enables the correlation of observed disease with cellular and molecular
mechanisms, leading to the discovery of new opportunities for improving the
natural history of mitral valve disease.