Degenerative Aortic Valve Disease, its Mechanism on Progression, its Effect on the Left Ventricle and the Postoperative Results

Pathology of CAVS

Author(s): Wilhelm Peter Mistiaen

Pp: 21-62 (42)

DOI: 10.2174/9781608052875113010005

* (Excluding Mailing and Handling)

Abstract

The pathological changes in CAVS are much more than a simple age related “wear and tear”. There is some resemblance of CAVS with atherosclerosis, but important differences have also been authenticated. Both conditions share a number of risk factors, however

The mechanisms leading to the microscopically observable changes in CAVS include many molecules and pathways. There is a considerable “cross talk” between these mechanisms which makes their description difficult.

The unravelling of these pathways requires a description in layers.

The outer layer consists of the risk factors of which the most common are lipid disorders and hypertension.

The middle layer consists of the molecules and mediators involved. Some of these molecules are inflammatory, others are the result of mechanical or oxidative stress, still others play a role in the remodelling of the ECM.

The inner layer consists of the mechanisms, which are inflammation, calcification or ossification, angiogenesis, remodelling of the ECM and programmed cell death.

The unravelling of these processes in CAVS is an ongoing process and is still not completely understood. This understanding might have some consequences in terms of prevention or slowing down of the process.


Keywords: Angiotensin, apoptosis, atheromatosis, autophagy, calcification, Heyde’s syndrome, inflammation, lipid infiltration, mechanical stress, neoangiogenesis, osteoblastic differentiation, oxidative stress, vitamin K antagonists.

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      • 11. app/Models/ContentAccess.php:647
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59354538 and j.to_ip >=59354538 )) and ((j.from_date <= 1739848422 and j.to_date >= 1739848422 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4695) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59354538 and j.to_ip >=59354538 )) and ((j.from_date <= 1739848422 and j.to_date >= 1739848422 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4695) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59354538 and j.to_ip >=59354538 )) and ((j.from_date <= 1739848422 and j.to_date >= 1739848422 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4695)
      790μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1141 and `b`.`banner_from_date` <= 1739848422 and `b`.`banner_to_date` >= 1739848422 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.5msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1141
      • 3: 1739848422
      • 4: 1739848422
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='081ea813ac127997835fd73a3bdef00f'
      280μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    13Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        5s26cWWvinzWx3ZA64SAMEJSAdua0vGNaIfRB5tH
        uc_cart_id
        081ea813ac127997835fd73a3bdef00f
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4695" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/4695
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6Im5JQnkveXA4R1JiaUJMWFJGeGNVOUE9PSIsInZhbHVlIjoiU21GYXpxWm5SdVFUN3NFanQ2TktYUmVqMzBQYnNwWVVoNUpHU1N6ZzdYST0iLCJtYWMiOiI4YzZhYzYwZTQ0ODMzNWRiOTBlNTE3Njk4NTVkNWNkN2E3Yjg1OWEzMzFhNWVhZTVjNTk2MGZmNDg2YTdmNDhiIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6Im5JQnkveXA4R1JiaUJMWFJGeGNVOUE9PSIsInZhbHVlIjoiU21GYXpxWm5SdVFUN3NFanQ2TktYUmVqMzBQYnNwWVVoNUpHU1N6ZzdYST0iLCJtYWMiOiI4YzZhYzYwZTQ0ODMz" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Tue, 18 Feb 2025 03:13:42 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkxGVm1OeFQ5YklXSHN4a0dmUlFoMEE9PSIsInZhbHVlIjoiZE9PZFFwZzRhcHVIMTVvdWpFOWxORFc4ZW44NDBueFVKbkFiVC80WExuUVhRQW1JMmltR01FUUJOS0dSazZNanZFMG1vWDlUcjFheXZ3bWQ5UzdRSUV0Y2NjMGpsNzBERlRibms4SXZqREN4MHllNzFua251TFR1bnNVeURxWW0iLCJtYWMiOiJmZTNiOGQwYWYxMTQwMmI3YTgyNWVkYmFlNmI3Y2M3ZDcxYTE4NzY3ZDNmZjI4N2FhYzYwMzkwZWZjNzU1OTFiIiwidGFnIjoiIn0%3D; expires=Thu, 20 Feb 2025 15:13:42 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IkxGVm1OeFQ5YklXSHN4a0dmUlFoMEE9PSIsInZhbHVlIjoiZE9PZFFwZzRhcHVIMTVvdWpFOWxORFc4ZW44NDBueFVKbkFiVC80WExuUVhRQW1JMmltR01FUUJOS0dSazZNanZFMG1vW" 1 => "alphaeurekaselectnet_session=eyJpdiI6InU5TGtsMjhwUjhvcEVUUEdTWWZrT0E9PSIsInZhbHVlIjoiMGdCY3huOHZqUDltMEhWdG5sekpuU3JBVGNWY1doaUVVSzgyMnM3UEhiYUY5ZWRoNVhTQW44bGQ4MmpmQzNqQ1EvWEQ5SUdLOE9mMDNLNTBkd3VEd1pwejczQTA0cEU5RklDTERqRzg2VGRITkdtNlFsdGMxYjN1bklTUndGSFMiLCJtYWMiOiIzMTJlYjUwMGU4MmViY2I1MmJhZjJiOTdmY2Y0NDdmNDU2ZTM5ZGY2YTMxOTc1YzhmODU5NTA0NDliMjYwNzFmIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6InU5TGtsMjhwUjhvcEVUUEdTWWZrT0E9PSIsInZhbHVlIjoiMGdCY3huOHZqUDltMEhWdG5sekpuU3JBVGNWY1doaUVVSzgyMnM3UEhiYUY5ZWRoNVhTQW44bGQ" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkxGVm1OeFQ5YklXSHN4a0dmUlFoMEE9PSIsInZhbHVlIjoiZE9PZFFwZzRhcHVIMTVvdWpFOWxORFc4ZW44NDBueFVKbkFiVC80WExuUVhRQW1JMmltR01FUUJOS0dSazZNanZFMG1vWDlUcjFheXZ3bWQ5UzdRSUV0Y2NjMGpsNzBERlRibms4SXZqREN4MHllNzFua251TFR1bnNVeURxWW0iLCJtYWMiOiJmZTNiOGQwYWYxMTQwMmI3YTgyNWVkYmFlNmI3Y2M3ZDcxYTE4NzY3ZDNmZjI4N2FhYzYwMzkwZWZjNzU1OTFiIiwidGFnIjoiIn0%3D; expires=Thu, 20-Feb-2025 15:13:42 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IkxGVm1OeFQ5YklXSHN4a0dmUlFoMEE9PSIsInZhbHVlIjoiZE9PZFFwZzRhcHVIMTVvdWpFOWxORFc4ZW44NDBueFVKbkFiVC80WExuUVhRQW1JMmltR01FUUJOS0dSazZNanZFMG1vW" 1 => "alphaeurekaselectnet_session=eyJpdiI6InU5TGtsMjhwUjhvcEVUUEdTWWZrT0E9PSIsInZhbHVlIjoiMGdCY3huOHZqUDltMEhWdG5sekpuU3JBVGNWY1doaUVVSzgyMnM3UEhiYUY5ZWRoNVhTQW44bGQ4MmpmQzNqQ1EvWEQ5SUdLOE9mMDNLNTBkd3VEd1pwejczQTA0cEU5RklDTERqRzg2VGRITkdtNlFsdGMxYjN1bklTUndGSFMiLCJtYWMiOiIzMTJlYjUwMGU4MmViY2I1MmJhZjJiOTdmY2Y0NDdmNDU2ZTM5ZGY2YTMxOTc1YzhmODU5NTA0NDliMjYwNzFmIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6InU5TGtsMjhwUjhvcEVUUEdTWWZrT0E9PSIsInZhbHVlIjoiMGdCY3huOHZqUDltMEhWdG5sekpuU3JBVGNWY1doaUVVSzgyMnM3UEhiYUY5ZWRoNVhTQW44bGQ" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "5s26cWWvinzWx3ZA64SAMEJSAdua0vGNaIfRB5tH" "uc_cart_id" => "081ea813ac127997835fd73a3bdef00f" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4695" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-18 03:13:42GET/chapter/46951121915