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Aortic and Pulmonary Valve Fenestrations: An Acquired Anatomic Entity During Adult Life
Marios Loukas1,2,3, Shelleen Gowrie1, Yuqian Dai1
1Department of Anatomical Sciences, School of Medicine, St. George's University, West Indies.
Clinical Anatomy (New York, N.Y.)
|July 30, 2026
Summary
Heart valve fenestrations are common in adults but absent in fetuses, suggesting they are acquired after birth. This study analyzed adult and fetal hearts to understand their prevalence and characteristics.
Area of Science:
- Cardiovascular Anatomy
- Surgical Pathology
Background:
- Fenestrations in heart valves are not well understood.
- Their origin, whether congenital or acquired, remains unclear.
Purpose of the Study:
- To identify and characterize aortic and pulmonary valve fenestrations.
- To compare their prevalence and morphology in adult versus fetal hearts.
- To investigate the potential congenital or acquired nature of these fenestrations.
Main Methods:
- Endoscopic examination of 41 adult and 97 fetal human hearts.
- In situ visualization followed by dissection.
- Independent assessment of fenestration prevalence, distribution, and morphology.
Main Results:
- Fenestrations were absent in all fetal hearts.
- Identified in 75.61% of adult hearts (31/41), with 74 total fenestrations.
- Ovoid fenestrations predominated, particularly along leaflet edges in both aortic and pulmonary valves.
Conclusions:
- Valve fenestrations are likely acquired postnatally, not congenital anomalies.
- High prevalence in adults and absence in fetuses support an acquired etiology.
- Biomechanical factors may contribute to fenestration formation over time.
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