Tools and Techniques - Clinical: Fluoroscopic balloon sizing of the aortic annulus before transcatheter aortic valve replacement (TAVR) – follow the “right cusp rule”

Appropriate sizing of the transcatheter heart valve (THV) is an important factor in minimising and preventing transcatheter aortic valve replacement (TAVR)-related complications such as valve embolisation, annular rupture, and paravalvular aortic regurgitation (PAR).

Transoesophageal echocardiography (TEE) and multislice computed tomography (MSCT) are the established tools for measurement of the aortic annulus prior to the procedure1,2.

Most current THV systems require oversizing of the annulus to get an optimal fit1. Inappropriate oversizing can cause heart block, aortic root haematoma and rupture1. Procedure balloon sizing is an additional, valuable tool to have in the TAVR armamentarium. It can help ...