Abstract
It is well known that some serotoninergic drugs and neuroendocrine tumors producing serotonin (5-HT) may induce valvular heart disease by stimulation of proliferation of valvular cells via interaction with a 5-HT receptor type 2B. Serotonin could play a role in the pathogenesis of progressive valvular disease for example as a complication of rheumatic fever, in patients with congenital bicuspid aortic valves or in degenerative aortic valve stenosis. The initial inflammation in acute rheumatic fever seems to affect both right and the left-side cardiac valves. Some patients develop chronic right-sided valve disease, particularly in connection with septum defects, though left-sided valves typically are predominantly affected, indicating that high flow velocity and systemic pressure close to the valves may be central in the pathogenesis. Serotonin is transported in granules in blood platelets. Changes in platelet number and concentrations of substances released from platelets in patients with valvular disease indicate that serotonin is released locally by shear stress when passing through an abnormal valve. Accordingly, any functional changes (like bicuspid aortic valves and changes secondary to degeneration) in the valves may progress due to locally released serotonin. Unfortunately, due to serotonin release by sampling and preparation of plasma, local serotonin assessment is not possible. Nevertheless, we suggest that serotonin may play a role in valvular disease in general and that patients may benefit from treatment reducing the effect of serotonin on the heart.
Highlights
Heart valve disturbances of function like stenosis or insufficiency are serious conditions that may lead to the development of heart failure if untreated
We argue that serotonin may be a shared, important and poorly appreciated factor in the progression of valvular heart stenosis of different etiologies
That by some way or other, the streptococcus causing acute rheumatic fever triggers an inflammation in the heart valves that with exposure to systemic pressure and flow changes may result in a progressive valve destruction
Summary
Heart valve disturbances of function like stenosis or insufficiency are serious conditions that may lead to the development of heart failure if untreated. A century ago, acute rheumatic fever was the major cause of valvular heart disease, but during the last decades, this disease has more or less disappeared from the Western world [1] Other entities, such as congenital bicuspid aortic valves, are more prominent causes of aortic valve stenosis [2]. The destruction of valves at the right side of the heart, due to small bowel neuroendocrine tumor (NET) [3], is well known. In this short review, we argue that serotonin may be a shared, important and poorly appreciated factor in the progression of valvular heart stenosis of different etiologies
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