Aortic Annular Geometry and Sizing: Echocardiography

A complete and accurate assessment of the aortic annulus and the surrounding structures is accomplished non-invasively by on organized echocardiographic approch employing a variety of techniques. An approch with transthoracic and transesophageal imaging modalities using two-and three-dimensional image acquisition can completely inform the geometry, size and hemodyamic characteristics of the aortic annulus structures in preparation for transcatheter aortic valve replacement (TAVR). In addition to addressing the role of echocardiography for aortic annular geometry and sizing, this chapter also includes important considerations such as appreciation of the many anatomical structures that make up the aortic annular complex, the optimal imaging windows and views to appropriately interrogate structures, consideration of the limitations of echocardiography and appreciation of instances when another imaging modality may be appropriate. The goal of a full and accurate assessment of the aortic annular complex is to ensure patient suitability for TAVR, inform device size selection, alert the operator to potential complications and ultimately to ensure a safe transcatheter heart valve deployment.