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. 2021 Dec 3;9(4):139–146. doi: 10.1055/s-0041-1730294

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The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ )

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fig. 3 — Illustration of the underling process in bicuspid aortic valve (BAV) development. Involvement of one or more genes is the primary insult. This might be modulated by epigenetic factors, such as chromatin modifications and DNA methylation affecting genetic regulatory elements. Environmental factors, such as longstanding abnormal blood flow and hypertension, may also contribute to BAV outcome. The epigenetics illustration was modified from the ENCODE portal (https://www.encodeproject.org/).