Aortic valve fenestrations - a systematic review

Abstract

Background. Aortic valve fenestrations (AVFs) seem to be relatively common, however their impact in human heart disease is not entirely clear. Methods. To evaluate the spectrum of human diseases associated with AVFs, we conducted a systematic review to evaluate the published literature on this topic in English or Spanish languages. The search was conducted on two 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. 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.