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. 2020 Oct 9;21(20):7434. doi: 10.3390/ijms21207434

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© 2020 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

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ECM degradation and haemorrhages in atherosclerotic plaques, calcified native AVs, and failed BHVs. (A) Loss of the ECM integrity upon the protease- and fatigue-mediated degradation of the ECM components (indicated by red arrows), magnification 1000×. (B) Loss of the ECM fiber orientation (indicated by red arrows), magnification 2500×. (C) Haemorrhagic infiltration (indicated by red arrows) because of leaky plaque neovessels or the stress-induced penetration of the inflow valve surface, magnification 1000×. (D) Delamination of the neointimal and valvular tissue (indicated by red arrows) upon the accumulation of blood in the cavities formed after the ECM degradation, magnification 1000×. (E) Haemorrhagic infiltration of deep ECM layers (indicated by red arrows) upon the massive intraplaque or intravalvular bleeding, magnification 1000×.