Author + information
- Ramdas G. Pai, MD, FACC⁎ ()
- ↵⁎University of Southern California, Keck School of Medicine, Cardiology, 1510 San Pablo Street, #322, Los Angeles, California 90033
Caira et al. (1) need to be congratulated for demonstrating the presence and importance of chondrification and ossification processes in degenerative mitral and aortic valve diseases, respectively. Understanding these biological processes is instrumental in selecting therapies that may potentially retard these processes and improve clinical outcomes. Thinking beyond the mechanical solutions for valvular lesions is akin to the evolution of the thought process about coronary artery disease 20 years ago when the biological targets for therapy and prevention were entertained. There are potentially many molecular or cellular targets for valve disease modification. Mechanical factors such as shear stress, flow rate, and blood pressure, which may initiate these biological processes, are also potentially modifiable.
One can envision that the predominant process in a given valve may depend on the stage of the valve disease. For example, the inflammatory process may be more predominant in less stenotic aortic valves, and fibrosis, cartilage formation, and osseous transformation may be the latter, less modifiable processes. Was this the observation of the authors? There are also regional differences in the shear-stress distribution across the valve leaflets, which might result in different stages of the process in different parts of the valve. What were the differences in the biochemical and cellular processes across the extent of the valve leaflets? These may have implications in terms of timing of therapies and screening process for the therapies.
- American College of Cardiology Foundation