Implications of Hinge-Point Based Annular Plane with Abnormal Aortic Cusps in Transcatheter Aortic Valve Replacement: Advantage of Centerline Based Annular Plane Approach.

: A virtual aortic annular plane that is built using the three hinge-points, known as hinge-point based annular plane (HPAP), is routinely used during transcatheter aortic valve replacement (TAVR). Abnormal aortic cusps (AAC) with unequal length and size significantly influence the relationship of HPAP to the aortic root axis and pose challenges to valve deployment leading to paravalvular leak and valve embolization. Obtaining a centerline based aortic annular plane, in addition, may help in better understanding of valve deployment behavior in AAC.