Results Distinct and Overlapping Expression Patterns of Dll 4 , Jag 1 , and Notch 1 Intracellular

Congenital heart defects (CHDs) are the most common structural anomalies, affecting 0.8% of live births worldwide. Heart valve malformations, occurring either in isolation or in the context of syndromic disease, account for about one third of all CHDs. However, these estimates do not take into account the bicuspid aortic valve (BAV), which is present in ≈0.5% to 2% of the population. A BAV predisposes to valve calcification and stenosis, and complications in 30% of BAV patients result in more morbidity and mortality than all other CHD combined. Patients with aortic valve (AV) disease at any age manifest some type of structural malformation frequently in association with aortic coarctation or aneurysm, suggesting a common underlying developmental mechanism affecting the entire aortic root and thoracic aorta. Valve formation, best characterized in the mouse, begins with an epithelial–mesenchymal transition (EMT), whereby endocardial cells in the mouse E9.5 atrioventricular canal (AVC) and E10.5 outflow tract (OFT) detach from each other to yield mesenchyme Cellular Biology

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