Advancements, Gaps, Directions for Exosomes and miRNAs in Pulmonary Valve Diseases and Transcatheter Pulmonary Valve Replacement

As an important carrier of intercellular information transmission, exosomes regulate the physiological and pathological state of local or distant cells by carrying a variety of signal molecules such as microRNAs (miRNAs). Despite significant advancements in the exploration of miRNAs related to other valves, research focusing on miRNAs in pulmonary valve diseases (PVDs) remains relatively scarce. This study summarizes the research progress on exosomes and their miRNAs in PVDs and explores their potential associations with transcatheter pulmonary valve replacement (TPVR). MiRNA are crucial in right ventricular (RV) remodeling, cardiac function monitoring, and determining the timing for TPVR intervention. As drug carriers, exosomes play an important role in promoting myocardial angiogenesis, inhibiting apoptosis, and protecting the myocardium. However, the association between exosomes and miRNAs and the development of PVDs, particularly pulmonary regurgitation (PR), remains unclear. The molecular mechanisms of exosomes and miRNAs in PVDs and RV remodeling after TPVR have not been fully elucidated, and their application in postoperative treatment following TPVR is still in its infancy. Future research must focus on advancing fundamental studies, validating biomarkers, and enhancing clinical applications to achieve significant breakthroughs.