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• W2324886857 abstract "BackgroundFenestrations of the aortic valve (AV) cusps are a common finding in older adults and are believed to be the result of a degenerative process. Currently, the mechanism of fenestration development is unclear and there is a paucity of data describing the frequency and distribution of fenestrations in the AV cusps.Methods67 adult cadaveric hearts (73.2 ± 16.0 years) were harvested and dissected to the level of the aortic root. The cusps were inspected for fenestrations and measurements of the sinotubular junction diameter, inter-commissural distances and sinus depth were made. All three cusps were then excised and measurements of the cusp height, free-margin length, attached margin length and annular diameters were taken. Using these data, cusp perimeter and area were calculated.Results26 (38.9%) hearts had fenestrations of the AV cusps. Of those valves, 50% had one fenestrated cusp, 38.5% had two fenestrated cusps and 11.5% had fenestrations in all three cusps. 50% of the fenestrations were in the left coronary cusp (LCC), 33.3% in the right coronary cusp (RCC) and 16.7% in the non-coronary cusp (NCC). The free-margin length (33.71 vs. 30.11mm, p=0.003), attached length (52.14 vs. 46.74 mm, p=0.003), perimeter (85.85 vs. 76.86 mm, p=0.002) and area of the NCC (562.57 vs. 662.30, p=0.009) were significantly larger in hearts with AV fenestrations compared to those without. The perimeter, attached length and area of the RCC and free-margin length of the LCC, trended towards significant differences between the fenestrated and non-fenestrated groups. There were no differences in the annular diameter, sinotubular junction diameter, inter-commissural distances, sinus depth or cusp height. When comparing the dimensions of all cusps within the same valve, differences were noted between the fenestrated and non-fenestrated groups, as outlined in Table 1.Tabled 1ConclusionsFenestrations of the AV cusps occur most frequently in the LCC and least frequently in the NCC. Cusps with fenestrations tend to be larger than non-fenestrated cusps, with significant differences noted in the free-margin length, attached length, perimeter, and area of the NCC. Furthermore, most dimensions of the NCC and RCC are significantly larger than the LCC, in aortic valves with fenestrations but not in valves without fenestrations. We hypothesize that the eccentric nature of certain aortic valves results in unequal shear stress on the cusps leading to the development of fenestrations. Future work should investigate whether these data can help predict patients who may be at risk for valvular degeneration. BackgroundFenestrations of the aortic valve (AV) cusps are a common finding in older adults and are believed to be the result of a degenerative process. Currently, the mechanism of fenestration development is unclear and there is a paucity of data describing the frequency and distribution of fenestrations in the AV cusps. Fenestrations of the aortic valve (AV) cusps are a common finding in older adults and are believed to be the result of a degenerative process. Currently, the mechanism of fenestration development is unclear and there is a paucity of data describing the frequency and distribution of fenestrations in the AV cusps. Methods67 adult cadaveric hearts (73.2 ± 16.0 years) were harvested and dissected to the level of the aortic root. The cusps were inspected for fenestrations and measurements of the sinotubular junction diameter, inter-commissural distances and sinus depth were made. All three cusps were then excised and measurements of the cusp height, free-margin length, attached margin length and annular diameters were taken. Using these data, cusp perimeter and area were calculated. 67 adult cadaveric hearts (73.2 ± 16.0 years) were harvested and dissected to the level of the aortic root. The cusps were inspected for fenestrations and measurements of the sinotubular junction diameter, inter-commissural distances and sinus depth were made. All three cusps were then excised and measurements of the cusp height, free-margin length, attached margin length and annular diameters were taken. Using these data, cusp perimeter and area were calculated. Results26 (38.9%) hearts had fenestrations of the AV cusps. Of those valves, 50% had one fenestrated cusp, 38.5% had two fenestrated cusps and 11.5% had fenestrations in all three cusps. 50% of the fenestrations were in the left coronary cusp (LCC), 33.3% in the right coronary cusp (RCC) and 16.7% in the non-coronary cusp (NCC). The free-margin length (33.71 vs. 30.11mm, p=0.003), attached length (52.14 vs. 46.74 mm, p=0.003), perimeter (85.85 vs. 76.86 mm, p=0.002) and area of the NCC (562.57 vs. 662.30, p=0.009) were significantly larger in hearts with AV fenestrations compared to those without. The perimeter, attached length and area of the RCC and free-margin length of the LCC, trended towards significant differences between the fenestrated and non-fenestrated groups. There were no differences in the annular diameter, sinotubular junction diameter, inter-commissural distances, sinus depth or cusp height. When comparing the dimensions of all cusps within the same valve, differences were noted between the fenestrated and non-fenestrated groups, as outlined in Table 1.Tabled 1 26 (38.9%) hearts had fenestrations of the AV cusps. Of those valves, 50% had one fenestrated cusp, 38.5% had two fenestrated cusps and 11.5% had fenestrations in all three cusps. 50% of the fenestrations were in the left coronary cusp (LCC), 33.3% in the right coronary cusp (RCC) and 16.7% in the non-coronary cusp (NCC). The free-margin length (33.71 vs. 30.11mm, p=0.003), attached length (52.14 vs. 46.74 mm, p=0.003), perimeter (85.85 vs. 76.86 mm, p=0.002) and area of the NCC (562.57 vs. 662.30, p=0.009) were significantly larger in hearts with AV fenestrations compared to those without. The perimeter, attached length and area of the RCC and free-margin length of the LCC, trended towards significant differences between the fenestrated and non-fenestrated groups. There were no differences in the annular diameter, sinotubular junction diameter, inter-commissural distances, sinus depth or cusp height. When comparing the dimensions of all cusps within the same valve, differences were noted between the fenestrated and non-fenestrated groups, as outlined in Table 1. ConclusionsFenestrations of the AV cusps occur most frequently in the LCC and least frequently in the NCC. Cusps with fenestrations tend to be larger than non-fenestrated cusps, with significant differences noted in the free-margin length, attached length, perimeter, and area of the NCC. Furthermore, most dimensions of the NCC and RCC are significantly larger than the LCC, in aortic valves with fenestrations but not in valves without fenestrations. We hypothesize that the eccentric nature of certain aortic valves results in unequal shear stress on the cusps leading to the development of fenestrations. Future work should investigate whether these data can help predict patients who may be at risk for valvular degeneration. Fenestrations of the AV cusps occur most frequently in the LCC and least frequently in the NCC. Cusps with fenestrations tend to be larger than non-fenestrated cusps, with significant differences noted in the free-margin length, attached length, perimeter, and area of the NCC. Furthermore, most dimensions of the NCC and RCC are significantly larger than the LCC, in aortic valves with fenestrations but not in valves without fenestrations. We hypothesize that the eccentric nature of certain aortic valves results in unequal shear stress on the cusps leading to the development of fenestrations. Future work should investigate whether these data can help predict patients who may be at risk for valvular degeneration." @default.
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• W2324886857 date "2012-09-01" @default.
• W2324886857 modified "2023-09-30" @default.
• W2324886857 title "688 Fenestrations of the Aortic Valve Cusps: Are They Related to Variations in Cusp Size?" @default.
• W2324886857 doi "https://doi.org/10.1016/j.cjca.2012.07.622" @default.
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