![]() It is the virtual aortic annular ring and, thus, the lowest hinge-points of the aortic cusps that define the annulus measured for THV sizing. 11, 12 This review will describe the two-dimensional (2-D) and 3-D echocardiographic methods for sizing the aortic annulus for TAVR. 2-4 Multiple studies suggest that three-dimensional (3-D) transesophageal echocardiography (TEE) can accurately measure the annular aortic annulus 5-10 and improve prediction of complications. 1 Annular sizing as well as characterization of the peri-annular region (left ventricular outflow tract and proximal aortic root) may improve anticipation or avoidance of complications such as paravalvular regurgitation, left main occlusion, or annular rupture. For both balloon expandable as well as self-expanding transcatheter heart valves (THV) accurate assessment of annular anatomy has become an essential aspect of the pre-procedural assessment of every patient and determines the selection of valve size.
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