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Investigating Aortic Valve Calcification via Isolation and Culture of T Lymphocytes using Feeder Cells from Irradiated Buffy Coat
Published on: February 4, 2021
Calcification of left-sided valvular structures: evidence of a pro-inflammatory milieu
1Department of Cardiac Surgery, Christiana Hospital, 4755 Ogletown-Stanton Road, Suite 1E50, Newark, Delaware 19718, USA. hsherif@christianacare.org
Insights
Left-sided heart valves, particularly the aortic and mitral valves, are more prone to calcification. This study suggests a pro-inflammatory environment, not hemodynamics, may explain this left-sided predilection.
Area of Science:
- Cardiovascular Medicine
- Pathophysiology
- Inflammation Biology
Background:
- Cardiac valve calcification disproportionately affects left-sided valves (aortic, mitral).
- Hemodynamic and pressure differences between heart sides are potential, but unproven, causes.
- The underlying reason for this left-sided predilection remains elusive.
Purpose of the Study:
- To investigate the reasons behind the higher incidence of calcification in left-sided cardiac valves.
- To evaluate the roles of hemodynamics versus inflammation in left-sided valve calcification.
Main Methods:
- Comprehensive literature review using PubMed, Google Scholar, and other databases.
- Analysis of studies on normal and dystrophic calcification pathophysiology.
- Examination of native valve calcification incidence and distribution in various diseases.
Main Results:
- Left-sided valves show a higher predilection for calcification across most disease processes, including systemic diseases.
- Conditions with higher right-sided pressure/hemodynamics do not exhibit increased right-sided valve calcification.
- Pulmonary grafts in the aortic position calcify similarly to native aortic valves, despite identical hemodynamics.
Conclusions:
- Higher pressure and forceful hemodynamics are unlikely causes of left-sided valve calcification.
- A pro-inflammatory milieu in left-sided cardiac valve tissues is proposed as the primary driver.
- Further quantitative research is needed to confirm inflammatory differences between right- and left-sided valves.
Background And Aim Of The Study:
Calcification of the cardiac valves occurs more frequently on the left side, most commonly involving the aortic and mitral valves. The differences in hemodynamics and blood pressure between the right and left sides have been considered as possible causes. However, the reason for this preferential distribution remains unknown. It is hypothesized that a stronger pro-inflammatory milieu exists in the left side of the heart, and might be responsible for valve calcification occurring most frequently on that side.
Methods:
An extensive search of the medical literature using PubMed and Google Internet search engines and online databases, as well as textbooks and journals, was conducted. Search areas included the pathophysiology of normal and dystrophic calcification, and the incidence and distribution of native valve involvement in different diseases.
Results:
The majority of the disease processes affecting cardiac valves have an increased predilection for the left-sided valves. This was also found to be true in systemic diseases with cardiac involvement. Diseases where the right-sided valves are subjected to higher pressure and comparably forceful hemodynamics were found not to demonstrate a similar increase in the incidence of valve calcification. Pulmonary autografts or homografts in the aortic position appear not to demonstrate the same rate of calcification as their aortic counterparts, despite being subjected to the same hemodynamics.
Conclusion:
The reason for valve calcification occurring more frequently on the left side remains unknown. All available evidence does not support the proposal that a higher pressure and more forceful hemodynamics are causes for this observation. Rather, the data indicate that there is a pronounced pro-inflammatory milieu in the tissues of the left-sided cardiac valves, that may be responsible for such increased valve calcification. Further investigations are required in order to assess, quantitatively, the differences in inflammatory response between right- and left-sided cardiac valves.
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