title: Heart valve health, disease, replacement, and repair: a 25-year cardiovascular pathology perspective.
abstract: The past several decades have witnessed major advances in the understanding of the structure, function, and biology of native valves and the pathobiology and clinical management of valvular heart disease. These improvements have enabled earlier and more precise diagnosis, assessment of the proper timing of surgical and interventional procedures, improved prosthetic and biologic valve replacements and repairs, recognition of postoperative complications and their management, and the introduction of minimally invasive approaches that have enabled definitive and durable treatment for patients who were previously considered inoperable. This review summarizes the current state of our understanding of the mechanisms of heart valve health and disease arrived at through innovative research on the cell and molecular biology of valves, clinical and pathological features of the most frequent intrinsic structural diseases that affect the valves, and the status and pathological considerations in the technological advances in valvular surgery and interventions. The contributions of many cardiovascular pathologists and other scientists, engineers, and clinicians are emphasized, and potentially fruitful areas for research are highlighted.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115; Pathology and Health Sciences and Technology (HST), Harvard Medical School, 75 Francis Street, Boston, MA 02115. Electronic address: fschoen@partners.org.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Schoen
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Laboratory Medicine Program, University Health Network, Medical Sciences Building, 1 King's College Circle, Rm. 6275A, Toronto, Ontario M5S 1A8, Canada. Electronic address: avrum.gotlieb@utoronto.ca.
authors.forename: Avrum I
authors.initials: AI
authors.lastname: Gotlieb
mesh_terms: D000818:Animals; D002309:Cardiology / Q000379:methods* / Q000639:trends*; D006349:Heart Valve Diseases; D006801:Humans
keywords: Bioprosthesis; Calcification; Extracellular matrix; Fibrosis; Mechanical valve; Tissue engineering; Valve endocardial cell; Valve interstitial cell