Gulyaev N.I., Gaikova O.N., Peremyshlenko A.S., Kuznetsov V.V., Kozlov K.L., Galenko A.S.

Introduction. The gain of elderly persons in the population of industrial countries provides a high actuality to investigations of pathogenesis of calcific aortic valve stenosis (CAVS). The aim of the study. To specify the quality and quantity pattern of collagen main types I–VI in cases with calcific and normal aortic valve cusps. Methods. Were examined 12 aortic valve cusps (obtained intraoperatively), 6 normal aortic valves cusps (autopsy material) and 6 sclerotic aortic valves cusps (autopsy material). Hystological and immunohystochemicalexamples were executed. Morphometric evaluation of the content of different types of collagens was evaluated with the use the automated software Video-Test Master «Morphology 4.0». The analysis of variance was used, mean (M), the average error mean (m) and standard deviation (SD) were calculated. The significance of differences was assessed according to the Mann-Whitney U-test. The difference between the compared parameters was considered to be statistically significant if p≤0,05. Results. During the process of the progression of aortic valve stenosis within aorticvalve cuspsthere was established to appear non-cellular stroma with degenerative changed collagen, as well as decline of the content, spatial orientation and structure of collagen main types I, III and IV, irregular redistribution in the content of collagen type III amount, local fibrosis with deposits of collagen type I, and the gain in the amount of collagen types II and V, progressive destroying of the elastic membranethat significantly changes the ratio rigidity/elasticity of the structure, contributes to the formation not only fibrotic spots within the stroma of aortic valve cusps, but to the development of endothelial dysfunction and indicates to the pathological origin of changes with the formation of prerequisites for the diffuse impregnation of modified stroma with calcium salts. Conclusion. Initial formation of deposits of calcium salts was suggested to form not in focus of fibrosis with the maximal concentration of collagen type I but in sites with the low density of collagen I-type fibrils with local extraextensibility. In these areas the compensatory accumulation of the collagen types II and V preclude fromthe normalization of the stroma extensibility whereas the low content of collagen IV in the spots with the decline of the total amount of the cellular matrix elements promotes both to fibrils dissociation and the thickening of the structure of the aortic valve cusp with appearance of cavities of the various shape with calcific deposits.
calcific aortic valve stenosis, aortic valve cusps, extracellular matrix, collagen, elastic membrane

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