{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:27:19Z","timestamp":1760956039916},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Aortic valve fenestrations (AVFs) seem to be relatively common; however, their impact in human heart disease is not entirely clear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/j.pbj.0000000000000083","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T16:52:26Z","timestamp":1600361546000},"page":"e083","source":"Crossref","is-referenced-by-count":8,"title":["Aortic valve fenestrations: a review"],"prefix":"10.1097","volume":"5","author":[{"given":"Caixia","family":"Zhu","sequence":"first","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto"}]},{"given":"Sofia C.","family":"Torres","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal."}]},{"given":"Jos\u00e9 Pedro L.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto"},{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal."}]}],"member":"276","published-online":{"date-parts":[[2020,9]]},"reference":[{"key":"R3-20231106","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/BF02263811","article-title":"\u00dcber die atrophische Fensterung der Semilunarklappen und des Netzes","volume":"30","author":"Beneke","year":"1910","journal-title":"Arch Entwicklungsmech Organism."},{"key":"R4-20231106","first-page":"179","article-title":"Fenestrations of the semilunar valves","volume":"5","author":"Foxe","year":"1929","journal-title":"Am J Pathol."},{"key":"R5-20231106","first-page":"941","article-title":"Case records of Massachusetts General Hospital","volume":"245","author":"Castleman","year":"1951","journal-title":"N Engl J Med."},{"key":"R6-20231106","doi-asserted-by":"crossref","first-page":"993","DOI":"10.7326\/0003-4819-44-5-993","article-title":"Fenestrations of the aortic valve cusps as a cause of aortic insufficiency and spontaneous aortic valve cusp rupture","volume":"44","author":"Matthews","year":"1956","journal-title":"Ann Intern Med."},{"key":"R7-20231106","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/0002-9343(58)90295-X","article-title":"Fenestration of the semilunar cusps, and functional aortic and pulmonic valve insufficiency","volume":"24","author":"Friedman","year":"1958","journal-title":"Am J Med."},{"key":"R8-20231106","first-page":"521","article-title":"Massive aortic regurgitation by spontaneous rupture of a fibrous strand in a fenestrated aortic valve","volume":"7","author":"Akiyama","year":"1998","journal-title":"J Heart Valve Dis."},{"key":"R9-20231106","doi-asserted-by":"crossref","first-page":"751","DOI":"10.3109\/15513819209024230","article-title":"Sudden death in supravalvular aortic stenosis: fusion of a coronary leaflet to the sinus ridge, dysplasia and stenosis of aortic and pulmonic valves","volume":"12","author":"Sun","year":"1992","journal-title":"Pediatr Pathol."},{"key":"R10-20231106","first-page":"134","article-title":"Congenital quadricuspid aortic valve: report of nine surgical cases","volume":"9","author":"Yotsumoto","year":"2003","journal-title":"Ann Thorac Cardiovasc Surg."},{"key":"R11-20231106","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1253\/circj.68.439","article-title":"Pathogenetic significance of myxomatous degeneration in fenestration-related massive aortic regurgitation","volume":"68","author":"Akiyama","year":"2004","journal-title":"Circ J."},{"key":"R12-20231106","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s12574-012-0148-7","article-title":"Aortic regurgitation caused by fibrous strand rupture in a fenestrated aortic valve","volume":"10","author":"Akasaka","year":"2012","journal-title":"J Echocardiogr."},{"key":"R13-20231106","doi-asserted-by":"crossref","first-page":"e163","DOI":"10.1016\/j.jccase.2012.02.008","article-title":"Giant fenestration and fibrous strand rupture of aortic valve without massive regurgitation","volume":"5","author":"Ishige","year":"2012","journal-title":"J Cardiol Cases."},{"key":"R14-20231106","first-page":"10","article-title":"Acute aortic regurgitation due to spontaneous rupture of an aortic sigmoid report of nine cases","volume":"11","author":"Avay\u00fa","year":"2016","journal-title":"Insuficiencia Cardiaca."},{"key":"R15-20231106","first-page":"61","article-title":"Rheumatic aortic regurgitation in a patient with large congenital fenestrations in all three leaflets","volume":"6","author":"Jodati","year":"2014","journal-title":"J Cardiovasc Thorac Res."},{"key":"R16-20231106","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s00540-008-0718-z","article-title":"Anesthetic management for severe aortic regurgitation in an infant repaired by Ross procedure","volume":"23","author":"Watabe","year":"2009","journal-title":"J Anesth."},{"key":"R17-20231106","first-page":"369","article-title":"Congenital aortic regurgitation due to aortic valvar fenestration with associated aortic dissection","volume":"49","author":"Vaideeswar","year":"2003","journal-title":"J Postgrad Med."},{"key":"R18-20231106","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/0002-8703(91)90597-B","article-title":"Large aortic valve fenestrations producing chronic aortic regurgitation","volume":"122","author":"Kaplan","year":"1991","journal-title":"Am Heart J."},{"key":"R19-20231106","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1253\/jcj.52.437","article-title":"Quadricuspid aortic valve perforation resulting from bacterial endocarditis--2-D echo- and angiographic diagnosis and its surgical treatment","volume":"52","author":"Matsukawa","year":"1988","journal-title":"Jpn Circ J."},{"key":"R20-20231106","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1161\/01.CIR.20.4.587","article-title":"Successful repair of aortic insufficiency due to valvular fenestration","volume":"20","author":"Bailey","year":"1959","journal-title":"Circulation."},{"key":"R21-20231106","first-page":"49","article-title":"Characteristic echocardiographic manifestation in aortic-valve leaflet fenestration complicating infectious endocarditis","volume":"6","author":"Algom","year":"1987","journal-title":"J Cardiovas Ultrasonography."},{"key":"R22-20231106","first-page":"127","article-title":"Ruptured aortic cords","volume":"43","author":"Westlake","year":"1973","journal-title":"Aust N Z J Surg."},{"key":"R24-20231106","doi-asserted-by":"crossref","first-page":"S361","DOI":"10.1016\/j.cjca.2012.07.622","article-title":"Fenestrations of the aortic valve cusps: are they related to variations in cusp size?","volume":"28","author":"Losenno","year":"2012","journal-title":"Ca J Cardiol."},{"key":"R25-20231106","first-page":"26","article-title":"Fenestrations of the aortic valve cusps: an anatomical explanation?","author":"Losenno","year":"2012","journal-title":"Faseb J."},{"key":"R26-20231106","first-page":"133","article-title":"Visualization of aortic valve fenestration by three dimensional transesophageal echocardiography for aortic valve repair","volume":"128","author":"Mahara","year":"2014","journal-title":"Cardiology."},{"key":"R27-20231106","first-page":"358","article-title":"Post-coital acute rupture of a fenestrated aortic valve","volume":"26","author":"Roumy","year":"2017","journal-title":"J Heart Valve Dis."},{"key":"R28-20231106","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S1054-8807(99)00009-5","article-title":"Acute aortic regurgitation due to spontaneous rupture of a fenestrated cusp: report in a 65-year-old man and review of seven additional cases","volume":"8","author":"Blaszyk","year":"1999","journal-title":"Cardiovasc Pathol."},{"key":"R29-20231106","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/S0140-6736(00)85820-1","article-title":"Congenital aortic bicuspid valves associated with fenestration and gross mental deficiency","volume":"1","author":"Cook","year":"1933","journal-title":"Lancet."},{"key":"R30-20231106","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1161\/01.CIR.13.5.750","article-title":"Rupture of the aortic valve","volume":"13","author":"Proudfit","year":"1956","journal-title":"Circulation."},{"key":"R31-20231106","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/0002-8703(63)90325-9","article-title":"Aortic insufficiency secondary to spontaneous rupture of a fenestrated leaflet","volume":"66","author":"Marcus","year":"1963","journal-title":"Am Heart J."},{"key":"R32-20231106","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/0002-9149(66)90042-7","article-title":"A fatal complication of aortic valve fenestration. Coronary ostial obstruction by an engaged embolus","volume":"18","author":"Payan","year":"1966","journal-title":"Am J Cardiol."},{"key":"R33-20231106","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1136\/hrt.29.2.222","article-title":"Ageing changes in human heart valves","volume":"29","author":"Pomerance","year":"1967","journal-title":"Br Heart J."},{"key":"R34-20231106","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S0022-5223(19)42695-0","article-title":"Fenestration of aortic cusps causing aortic regurgitation","volume":"57","author":"Symbas","year":"1969","journal-title":"J Thorac Cardiovasc Surg."},{"key":"R35-20231106","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1161\/01.CIR.43.6.922","article-title":"Prolapse of semilunar cusps as causes of aortic insufficiency","volume":"43","author":"Carter","year":"1971","journal-title":"Circulation."},{"key":"R36-20231106","first-page":"367","article-title":"Aortic and pulmonary valve fenestrations as ageing indices in Down's syndrome","volume":"18","author":"Sylvester","year":"1974","journal-title":"J Ment Defic Res."},{"key":"R37-20231106","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1378\/chest.72.3.361","article-title":"Spontaneous rupture of bicuspid aortic valve. An unusual cause of aortic insufficiency","volume":"72","author":"Becker","year":"1977","journal-title":"Chest."},{"key":"R38-20231106","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/S0022-5223(19)41470-0","article-title":"Spontaneous rupture of a fenestrated aortic valve. Surgical treatment","volume":"73","author":"Moran","year":"1977","journal-title":"J Thorac Cardiovasc Surg."},{"key":"R39-20231106","first-page":"254","article-title":"Diastolic opening of the aortic valve (AV) in a case of aortic insufficiency due to AV fenestration","volume":"5","author":"Perez","year":"1978","journal-title":"Cardiovasc Dis."},{"key":"R40-20231106","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/BF00318944","article-title":"The surface anatomy of the human aortic valve as revealed by scanning electron microscopy","volume":"172","author":"Hurle","year":"1985","journal-title":"Anat Embryol (Berl)."},{"key":"R41-20231106","first-page":"187","article-title":"Quadricuspid aortic valve with centrally fenestrated leaflets causing aortic insufficiency","volume":"15","author":"Coltharp","year":"1988","journal-title":"Tex Heart Inst J."},{"key":"R42-20231106","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1055\/s-2007-1020156","article-title":"Congenital quadricuspid aortic valve associated with aortic regurgitation","volume":"40","author":"Aoyagi","year":"1992","journal-title":"Thorac Cardiovasc Surg."},{"key":"R43-20231106","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/1054-8807(95)00066-6","article-title":"A fenestrated aortic valve contributing to iatrogenic aortic insufficiency post mitral valve replacement","volume":"5","author":"Lee","year":"1996","journal-title":"Cardiovasc Pathol."},{"key":"R44-20231106","first-page":"535","article-title":"Congenitally bicuspid aortic valves: study of a variant with fenestrated raphe","volume":"10","author":"Walley","year":"1994","journal-title":"Can J Cardiol."},{"key":"R45-20231106","first-page":"692","article-title":"Incidental mobile aortic valve lesion: a case of aortic valve fenestration","volume":"16","author":"Bourgault","year":"2007","journal-title":"J Heart Valve Dis."},{"key":"R46-20231106","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1177\/021849230801600522","article-title":"Congenital quadricuspid aortic valve associated with severe regurgitation","volume":"16","author":"Kawanishi","year":"2008","journal-title":"Asian Cardiovasc Thorac Ann."},{"key":"R47-20231106","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.athoracsur.2008.06.073","article-title":"Aortic valve commissural fenestrations due to sinus of valsalva dilatation","volume":"87","author":"Reade","year":"2009","journal-title":"Ann Thorac Surg."},{"key":"R48-20231106","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/j.athoracsur.2009.06.106","article-title":"Commissural fenestrations are not contraindication for aortic valve and root repair","volume":"88","author":"Urbanski","year":"2009","journal-title":"Ann Thorac Surg."},{"key":"R49-20231106","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jtcvs.2009.06.025","article-title":"Aortic valve reconstruction in myxomatous degeneration of aortic valves: are fenestrations a risk factor for repair failure?","volume":"139","author":"Schafers","year":"2010","journal-title":"J Thorac Cardiovasc Surg."},{"key":"R50-20231106","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.athoracsur.2012.02.004","article-title":"Fenestrated rudimentary aortic valvular cusp: report of a case with dilatated cardiomyopathy","volume":"94","author":"Yamasaki","year":"2012","journal-title":"Ann Thorac Surg."},{"key":"R51-20231106","doi-asserted-by":"crossref","first-page":"S165","DOI":"10.1016\/j.hlc.2013.05.394","article-title":"Aortic valve fenestration\u2014an under reported observation in aortic regurgitation (AR)","volume":"22","author":"Cheruvu","year":"2013","journal-title":"Heart Lung Circ."},{"key":"R52-20231106","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1536\/ihj.14-044","article-title":"Aortic regurgitation due to fibrous strand rupture in the fenestrated left coronary cusp of the tricuspid aortic valve","volume":"55","author":"Irisawa","year":"2014","journal-title":"Int Heart J."},{"key":"R53-20231106","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s12574-014-0214-4","article-title":"Early failure of quadricuspid aortic valve tricuspidization due to dehiscence of approximating coronary cusps","volume":"12","author":"Ohira","year":"2014","journal-title":"J Echocardiogr."},{"key":"R54-20231106","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/jocs.12451","article-title":"Aborted TAVR following aortic balloon valvuloplasty","volume":"30","author":"Algarni","year":"2015","journal-title":"J Card Surg."},{"key":"R55-20231106","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1093\/ehjci\/jew177","article-title":"Aortic fenestration mimicking aortic perforation","volume":"18","author":"Ganguli","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging."},{"key":"R56-20231106","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1253\/circj.CJ-16-0959","article-title":"Acute aortic valve regurgitation due to spontaneous rupture of fenestrated cusp treated with aortic valve repair","volume":"81","author":"Mahara","year":"2017","journal-title":"Circ J."},{"key":"R57-20231106","doi-asserted-by":"crossref","first-page":"694","DOI":"10.14260\/Jemds\/2017\/150","article-title":"Variations in the number and morphology of cusps of aortic valve- anatomical and surgical relevance","volume":"6","author":"Ashalatha","year":"2017","journal-title":"J Evol Med Dent Sci."},{"key":"R58-20231106","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s11748-017-0766-0","article-title":"Valve-sparing aortic root re-implantation for commissural detachment with fibrous strand","volume":"66","author":"Matsukuma","year":"2018","journal-title":"Gen Thorac Cardiovasc Surg."},{"key":"R59-20231106","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.mayocp.2018.11.034","article-title":"Contemporary etiologies, mechanisms, and surgical approaches in pure native aortic regurgitation","volume":"94","author":"Yang","year":"2019","journal-title":"Mayo Clin Proc."},{"key":"R60-20231106","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"38","author":"Baumgartner","year":"2017","journal-title":"Eur Heart J."}],"container-title":["Porto Biomedical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/j.pbj.0000000000000083","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T02:02:24Z","timestamp":1699236144000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/j.pbj.0000000000000083"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":57,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1097\/j.pbj.0000000000000083","relation":{},"ISSN":["2444-8664"],"issn-type":[{"value":"2444-8664","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}