Abstract
Aortic valve fenestrations are defined as a loss of aortic valve leaflet tissue. They are a common but overlooked finding with unclear significance. The aim of this study was to investigate the varied functional anatomies of aortic valve fenestrations. A total of 400 formalin-fixed autopsied human hearts were macroscopically assessed and the function of the aortic valve of 16 reanimated human hearts were imaged using Visible Heart® methodologies. Aortic valve leaflet fenestrations were present in 43.0% of autopsied hearts (in one leaflet in 24.0%, in two leaflets 16.0%, in all leaflets 3.0%). Fenestrations were mostly present in left (25.5%) followed by right (23.3%) and noncoronary leaflet (16.3%). In 93.8% of cases, the fenestrations form clusters and were mainly located at the free edge of the leaflet in the commissural area (95.4%). Hearts with aortic valve fenestrations had significantly larger aortic valve diameters and aortic valve areas (p < 0.001). The average surface area sizes of fenestrations were 23.8 ± 16.6 mm2, and the areas were largest for left followed by right and noncoronary leaflet fenestrations (p < 0.001). The fenestration areas positively correlated with donor age (r = 0.31; p = 0.02). Significant hypermobility and subjective weakening of the leaflet adhesion levels of the fenestrated regions were observed. In conclusion, fenestrations of the aortic leaflets are frequent, and their sizes may be significant. They occur in all age groups, yet their size increase with aging. Fragments of leaflets with fenestrations show different behaviors during the cardiac cycle versus unchanged areas.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 612-617 |
| Number of pages | 6 |
| Journal | Clinical Anatomy |
| Volume | 36 |
| Issue number | 4 |
| DOIs | |
| State | Published - May 2023 |
Bibliographical note
Funding Information:The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude. We show our gratitude to the patients and families who have donated their hearts for research, and to LifeSource (MN, USA) for their assistance in the recovery and transport of the organs. The Visible Heart® Laboratory was supported in part by the Institute for Engineering in Medicine, the Lillihei Heart Institute and through a research contract with Medtronic.
Publisher Copyright:
© 2023 American Association of Clinical Anatomists and British Association of Clinical Anatomists.
Keywords
- aorta
- aortic cusp
- aortic fenestration
- aortic leaflet
- aortic root
- aortic valve
- fenestrated cusp
- fenestrated leaflet
- sinus of Valsalva