Aortic valve fenestrations: a review

Abstract

Background: Aortic valve fenestrations (AVFs) seem to be relatively common; however, their impact in human heart disease is not entirely clear. Methods: A review was carried out to assess all scientific literature on human patients related to AVFs, as described in the published literature. The search was conducted on 2 different databases, Medline (PubMed), and ISI Web of Knowledge. Results: Fifty-five reports were under analysis. Autopsy studies showed AVFs to be present in 55.9% of individuals studied in such studies. They occur more frequently in men and, in general, their frequency increases with age. Although common, fenestrations rarely cause regurgitation; however, they may play an important role in the pathophysiology of some cases of severe aortic regurgitation. AVFs have been described in patients with Down syndrome and Marfan syndrome, in patients with bicuspid or quadricuspid valves, and in patients with myxomatous valvular degeneration. Echocardiographic assessment of aortic regurgitation seems to have limitations in the diagnosis of valvular fenestrations. Conclusions: Fenestrations of the aortic valve are very common and are associated with certain clinical conditions. It is unknown if AVFs play any role in the current epidemic of aortic valve disease. Future studies should aim to better define the role of AVFs in aortic valve disease, to further understand its etiology and to develop diagnostic criteria.

Aortic valve fenestrations: Macroscopic assessment and functional anatomy study

“…Yet, a recent report by Yang et al suggested that aortic valve fenestrations may account for 3.1% of moderately severe and severe aortic valve insufficiencies (Yang et al, 2019). Moreover, many case reports have described fenestration-associated aortic valve regurgitations (Jodati et al, 2014;Symbas et al, 1969;Zhu et al, 2020). Especially, the in the patient in which the presence of multiple and large fenestrations exist, these F I G U R E 2 Functional endoscopic view of the aortic valve with multiple fenestrations in leaflets.…”

“…It is still not entirely clear, whether fenestrations in aortic valve leaflets may play significant role in the pathophysiologies of various aortic valve diseases (Zhu et al, 2020). Nevertheless, the presence of the aortic leaflet fenestrations has been linked to hemodynamically significant aortic valve regurgitations (Yang et al, 2013;Zhu et al, 2020); especially, if large and centrally located apertures in the leaflet structure are present which may be responsible for a leaky valve (Jodati et al, 2014). The presence of the fenestrated regions within the valvular tissues may lead to the significant losses of leaflet stiffnesses and therefore be associated with prolapses (Yang et al, 2019).…”

“…Aortic valve fenestrations, defined as an aperture/loss of tissue in the human aortic valve leaflets are common, but often overlooked entities, with unclear significances (Ashalatha & Hannah Noone, 2017; Friedman & Hathaway, 1958; Roberts et al, 2019; Whiteman et al, 2020; Zhu et al, 2020). It is estimated that they may be present in every second human, and in all age groups (Zhu et al, 2020). As the fenestrations may be observed already in fetal life, they perhaps should be considered as a congenital form of tissue atrophy (Foxe, 1929).…”

“…Fenestrations may be found in all of the three leaflets of the aortic valves, as well as presenting in bicuspid or quadricuspid valves (Mizoguchi et al, 2014; Yang et al, 2019). Although the fenestrations tends to be located preferably in the commissural valve regions, they can occur in any place of any valve leaflet (Zhu et al, 2020).…”

A heart in a heart: a case report of spontaneous flail of bicuspid aortic valve

“…Fenestration of aortic valve is a common condition that rarely cause aortic incompetency. In one study, it accounts for 3.1% of AR mechanisms among patients [ 9 ].Usually, fenestrations are located in the commissures, and their frequency is higher in men, BAV, and valves with myxomatous degeneration. Regurgitation can occur in large fenestration or, in rare cases, in spontaneous rupture of fenestration [ 10 ].…”