Growth and remodeling of atrioventricular heart valves: A potential target for pharmacological treatment?

The atrioventricular heart valves, i.e., the mitral valve and the tricuspid valve, play vital roles in our cardiovascular system. Disease of these valves is therefore a significant source of morbidity and mortality. Unfortunately, current treatment options are suboptimal with significant rates of failure. It was only recently that we have begun to appreciate that the atrioventricular heart valve leaflets are not just passive flaps, but actively (mal-)adapting tissues. This discovery sheds new light on disease mechanisms and provides, thus, possible pathways to new treatments. In this current opinion piece, we examine the state of our knowledge about the (mal-)adaptive mechanisms (physiological and pathological growth and remodeling) of the atrioventricular heart valves. Furthermore, we review the evidence that suggests that valve maladaptation may be a target for pharmacological treatment of diseased valves which, in the future, could transform clinical practice.