Presence of a smooth muscle system in aortic valve leaflets.

The location and the spatial arrangement of smooth muscle cells in aortic valves have been assessed by a systematic analysis of serial semithin sections of plastic embedded porcine and human aortic leaflets, combined with an electron microscope study. The investigation showed that smooth muscle cells, either single and arranged in thin bundles, and other cell types such as myofibroblasts are constantly present in the aortic valve leaflets. In addition, it was possible to devise a model of the three dimensional, specific organization of the smooth muscle bundles which can be interpreted as an intrinsic muscle system of the leaflets. As the muscular elements might play an active role in the normal functioning of the valve, their presence should be taken into account in designing (bio)prosthetic leaflets and in the evaluation of valve pathology.