Cellular and Molecular Basis of Remodeling in Valvular Heart Diseases
Heart Valve Diseases
Much remains to be learned about the pathobiology of valvular heart diseases at the cellular and molecular levels. It seems clear at this point, however, that important pathophysiologic differences exist between the responses to left ventricular pressure loading (AS) and to volume loading (AR and MR), and similarly important differences exist in the responses to the two volume-loading lesions, based on the dissimilarities in mechanical stresses and strains that impact on the left ventricle from these lesions. The effects of these mechanical influences are felt by myocardial cardiomyocytes and fibroblasts, and perhaps by other cellular elements. The pathophysiology of myocardial dysfunction is undoubtedly the net result of metabolic alterations and remodeling of the structure and secretory activities of these different cell lines. As increasing knowledge further elucidates the mechanisms by which abnormal mechanical influences are transduced to disordered myocardial cell biology, it is reasonable to foresee a time when the clinical debility associated with valve diseases will be mitigated by nonsurgical modulation of myocardial biology and the decision to apply direct mechanical therapy will be undertaken based on interrogation of cellular processes with precision that is not currently possible. © 2007 Elsevier Inc. All rights reserved.
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