Heart valves are sophisticated cellularised structures that perform a complex series of
dynamic functions during each cardiac cycle. The endothelial cells (ECs) that cover both surfaces of
the valve, play an important role in ensuring that the valve functions are in an optimal manner. They
are also postulated to protect the valve against calcific disease. These functions include a role in
embryonic development, regulation of cellular attachment, modulation of the mechanical properties of
the valve, prevention of valve interstitial cell differentiation into pathological cell phenotypes and
regulation of the valve extracellular matrix. It is believed that valve endothelial cells (VECs) are a specialised population
of ECs which have a distinctive range of properties not seen elsewhere in the vasculature. This allows them to function in
a unique haemodynamic environment. Each surface of the valve is exposed to vastly different patterns of blood flow and
levels of shear stress, resulting in further specialisation of the VECs on the aortic and ventricular surfaces of the valve.
This review will examine the role of VECs on either surface of the valve and demonstrate how they contribute to the function
and durability of heart valves.
Keywords: Aortic valve, aortic stenosis, biomechanics, extracellular matrix, valve development, shear stress, nitric oxide.
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