The epidemiology of degenerative mitral valve disease: Chicken and egg, the old conundrum

Abstract

So-called degenerative mitral valve disease has its origins as a genetic aberration. In other words it is a developmental failure. It operates at some of the highest pressures in nature and demands sound structural integrity to function for a human lifespan. The normally functioning valve is a biological wonder of the natural world.

This valve serves three primary functions:

1. Valve competency
2. The ability to allow low resistance rapid changes in flow rate
3. Support of normal left ventricular function

Degenerative valves are morphologically malformed at both the microscopic and macroscopic levels. It has a familial component. The two principal forms are the Barlow’s valve and the mural leaflet prolapse . Each present at different ages, with Barlow’s earlier in life and the most common type, mural leaflet prolapse in the latter third of life.

Evidence is accumulating at a molecular level which supports this contention and will be discussed in this paper. Engineering analysis can explain the mode of failure. This paper will discuss these aspects of mitral regurgitation, the most common valve lesion and explore the molecular basis for it.