---
title: "Thoracic Aorta and Great Vessel Anatomy"
docid: "67498b94-770a-47ee-bd74-622b5e0b6817"
authors:
  - key: "9fea2857-d729-4fe4-b4fd-3b7bf1db23cf"
    value: "Mortadha Al-Kinani, MD, MBChB"
  - key: "3d1e4c57-c1cf-4c89-b0f0-5d82b29a31e1"
    value: "Suhny Abbara, MD, FACR, MSCCT, FNASCI"
breadcrumbs:
  -
    name: "Cardiac"
    slug: "cardiac"
    treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
  -
    name: "Anatomy"
    slug: "anatomy"
    treeNodeId: "d43d6d86-daf5-4eec-b2df-c88744ec7f32"
  -
    name: "Thoracic Aorta and Great Vessel Anatomy"
    slug: "thoracic-aorta-and-great-vessel-an-"
    treeNodeId: null
category: "Cardiac"
documentVersionId: "c2ccfda5-f93e-4770-bd79-17554ce23db9"
imageCount: 21
lastUpdated: "01/23/25"
pageDescription: "Thoracic Aorta and Great Vessel Anatomy"
pageKeywords: "Cardiac, Anatomy, Thoracic Aorta and Great Vessel Anatomy"
pageTitle: "Thoracic Aorta and Great Vessel Anatomy | STATdx"
enhancedTitle: "Thoracic Aorta and Great Vessel Anatomy"
type: "ANATOMY"
references: true
breadcrumbs:
  - "Cardiac"
  - "Anatomy"
  - "Thoracic Aorta and Great Vessel Anatomy"
---
# TERMINOLOGY

- ## Definitions
  
  
    - Aortic root
          - Anulus to sinotubular junction (STJ)
    - Ascending aorta (AsAo)
          - Extends up to origin of brachiocephalic trunk
    - Aortic arch or transverse aorta
          - From brachiocephalic trunk to ligamentum arteriosum
          - Ligamentum arteriosum is remnant of ductus arteriosus and typically lies immediately distal to origin of left subclavian artery (SCA)
    - Aortic isthmus
          - Segment of distal aortic arch between left subclavian origin and ligamentum arteriosum
    - Descending thoracic aorta (DsAo)
          - Ligamentum arteriosum to diaphragmatic hiatus

# IMAGING ANATOMY

- ## Overview
  
  
    - Thoracic aorta divided into 4 segments from proximal to distal
          - Aortic root
          - AsAo
          - Aortic arch
          - DsAo
    - Aortic root extends from aortic anulus to STJ
          - Aortic anulus
                  - Virtual ring at base of aortic root defined by lowest attachment point of aortic cusps; cusp attachment site has complex crown shape
                  - Typically elliptical shape
                  - Important for sizing of aortic valve replacement
          - Sinuses of Valsalva (SoVs)
                  - 3 sinuses defined by coronary origins
                  - Left coronary artery arises from left coronary sinus
                  - Right coronary artery arises from right coronary sinus
                  - Interatrial septum points toward noncoronary sinus, which is typically located posteriorly and to right on axial images
                  - SoV typically greatest caliber segment of thoracic aorta
          - STJ
                  - Anatomic landmark dividing aortic root from tubular AsAo
                  - Narrower than SoVs
    - AsAo extends from STJ to origin of brachiocephalic trunk
          - Typically greatest in diameter and nearly orthogonal to axial plane at right pulmonary artery level, which is convenient and standard level of measurement
    - Aortic arch extends from brachiocephalic trunk to ligamentum arteriosum
          - Distal arch or aortic isthmus short (~ 2-cm) segment between left subclavian origin and remnant of ductus arteriosus
          - Aortic isthmus typically narrower than adjoining aortic segments
          - If ligamentum arteriosum cannot be identified, aortic arch can also be defined as extending past left subclavian origin
          - Ductus diverticulum (or "bump"): Focal, smooth bulge at site of obliterated ductus arteriosus along undersurface of isthmus
                  - Normal variant that can be mistaken for traumatic aortic injury, which also occurs at this location
                  - May become aneurysmal (> 3 cm)
    - Aortic arch branch vessels to head, neck, upper extremities, and chest wall termed great vessels
          - Brachiocephalic trunk (innominate artery): 1st and largest of great vessels of aortic arch; divides into right common carotid artery (CCA) and SCA
                  - Right SCA branches include right internal mammary, vertebral artery (VA), thyrocervical, costocervical, and long thoracic arteries, and it continues as axillary artery after margin of 1st rib
                  - Right CCA divides into internal carotid artery (ICA) and external carotid artery (ECA) in neck
          - Left CCA is 2nd great vessel from arch
                  - Divides into ICA and ECA
          - Left SCA is 3rd and final great vessel from arch
                  - Gives off internal mammary, VA, thyrocervical, costocervical, and long thoracic arteries and continues as axillary artery
          - Rare (3%) thyroid ima or thyroidea ima with inferior thyroid artery arises directly from aortic arch or innominate artery as opposed to normal origin from thyrocervical trunk
    - DsAo extends from distal arch to diaphragmatic hiatus, where it continues as abdominal aorta
          - Descending aorta typically smaller in caliber than AsAo
          - Aortic spindle: Bulge in proximal descending aorta just distal to isthmus
                  - Commonly seen in children but can persist into adulthood
    - Descending aorta gives off important small arteries
          - Bronchial arteries
          - Intercostal arteries
                  - Supreme intercostals supply T1-T3; arise from costocervical trunk of SCAs
                  - Paired intercostals arise directly from descending aorta from T4-T12
          - Thoracic spinal cord supply comes from DsAo
                  - Anterior spinal artery supplied from intercostal and bronchial arteries at T4-T5
                  - Artery of Adamkiewicz arises from intercostal arteries at T6-T12 (75%)
          - Esophageal, pericardial, superior phrenic, and other miscellaneous mediastinal branches
    - Central venous anatomy
          - Jugular veins
                  - Internal jugular veins drain head and neck; joined by external jugular veins draining face and scalp
          - Subclavian veins
                  - Originate at axillary vein transition at 1st rib margin
                  - Typically valveless; joined by cephalic vein
          - Brachiocephalic veins
                  - Formed by junction of subclavian and internal jugular veins
                  - Right: Short and vertical; left: Longer and crosses mediastinum anterior to great vessels
                  - Tributaries: Internal mammary, vertebral, pericardiophrenic, 1st intercostal, inferior thyroidal
          - Superior vena cava (SVC)
                  - Formed by right and left brachiocephalic veins
                  - 6-8 cm long, up to 2 cm in diameter
                  - Azygos vein joins above pericardium; SVC enters right atrium
- ## Anatomy Relationships
  
  
    - Aortic arch variants
          - Right aortic arch (< 0.1%); 2 types
                  - Mirror-image branching (65%); associated with cyanotic congenital heart disease in 90%
                  - Aberrant left SCA or other great vessel origin (35%); not associated with cyanotic congenital heart disease
                  - Dilated origin of aberrant left SCA in 60%; Kommerell diverticulum; if also ligamentum arteriosum → vascular ring and tracheal compression
          - Double (duplicated) aortic arch (< 0.1%)
                  - Arises from 3rd rather than 4th branchial arch
                  - High location in chest, near lung apex
                  - May have anomalous great vessel origins
          - Coarctation (< 0.1%)
                  - Congenital narrowing of aortic arch, usually distal to left subclavian origin
                  - May be preductal (infantile), juxtaductal, or post ductal (adult)
                  - Common with other congenital aortic pathology, such as bicuspid aortic valve and Turner syndrome
    - Great vessel origin variants
          - Bovine arch (20%): Left CCA may have common origin with or arise from innominate artery
          - 4-vessel arch (5%): Left VA may arise directly from aortic arch between left CCA and left SCA rather than from left SCA
          - Aberrant right SCA: Right SCA may arise separately from aortic arch, distal to left SCA
                  - Diverticulum of Kommerell: Dilatation at origin of aberrant right SCA; can be associated with dysphagia (dysphagia lusoria) when large

# ANATOMY IMAGING ISSUES

- ## Imaging Recommendations
  
  
    - Thoracic aorta imaged with catheter angiography, transthoracic or transesophageal echocardiography, and CT or MR angiography
    - CT angiography: Protocol may include noncontrast, arterial, and delayed-phase imaging
          - Noncontrast images helpful in cases of extensive calcium, prior surgery, or suspicion for intramural hematoma
          - Delayed images better delineate mediastinal anatomy and are also helpful in postsurgical patients when concern for endoleak
          - Noncontrast and delayed images often not necessary for routine follow-up of known aortic aneurysm
          - Thin-section (≤ 1.25-mm) reconstruction preferred
          - ECG-gated or high-pitch dual-source CT preferred for accurate evaluation of aortic root due to cardiac motion artifact if root pathology suspected or followed
    - MR angiography: Contrast angiography preferred
          - Noncontrast sequences often give diagnostic study and are test of choice when contraindication to iodinated and gadolinium contrast agent
    - In general, for follow-up exams, best to employ consistent imaging modality and measurement technique
    - "Candy cane" oblique view places thoracic aorta in profile and is commonly employed for catheter, CT, and MR angiography
    - Aortic measurement should be performed in plane orthogonal to longitudinal axis of aorta
          - Measurements made in axial plane may be oblique to aorta and less accurate and reproducible
- ## Transcatheter Aortic Valve Implantation/Replacement Assessment
  
  
    - For severe aortic stenosis in nonsurgical patients
    - Transfemoral or transapical approach may be chosen
    - CT angiography plays increasing role in sizing of aortic anulus and determining suitability of iliofemoral approach
    - Indications and criteria evolving
    - PARTNER trial exclusion criteria
          - Native aortic anulus size < 18 mm or > 25 mm
          - Iliofemoral vessels too calcified or small to accommodate 22-Fr or 24-Fr introducer sheath (minimum luminal diameter of 7-8 mm, respectively)
          - Severe aortic or iliofemoral disease that would preclude safe placement, such as aneurysm, tortuosity, extensive atheroma, or dissection
          - Bulky, calcified aortic valve leaflets in close proximity to coronary ostia

 c0614a38-3d8e-4373-8881-b9966f67112d

## References

# Selected References

1. [Feldstein E et al: A novel variant of the aortic arch great vessels. Clin Neurol Neurosurg. 214:107172, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35158165%5Bpmid%5D)
1. [Smith CR et al: Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 364(23):2187-98, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21639811%5Bpmid%5D)
1. [Hiratzka LF et al: 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation. 121(13):e266-369, 2010. Erratum in: Circulation. 122(4):e410, 2010](http://www.ncbi.nlm.nih.gov/pubmed/?term=20233780%5Bpmid%5D)
1. [Agarwal PP et al: Multidetector CT of thoracic aortic aneurysms. Radiographics. 29(2):537-52, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19325064%5Bpmid%5D)
1. [Leipsic J et al: The evolving role of MDCT in transcatheter aortic valve replacement: a radiologists' perspective. AJR Am J Roentgenol. 193(3):W214-9, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19696262%5Bpmid%5D)
1. [Davies M et al: Developmental abnormalities of the great vessels of the thorax and their embryological basis. Br J Radiol. 76(907):491-502, 2003](http://www.ncbi.nlm.nih.gov/pubmed/?term=12857711%5Bpmid%5D)


## Images


### Thoracic Aorta and Great Vessels

![Graphic depicts the thoracic aorta and great vessel origins.](images/app.statdx.com_image_thumbnail_5542954e-1454-4885-9e54-7d37eeb27a45_annotated_false_size_900_quality_90_6fd57d4034cfd86dc292921a9a5f4c191f1e698d.jpg)
*Graphic depicts the thoracic aorta and great vessel origins.*

![Graphic depicts the thoracic aorta and great vessel origins.](images/app.statdx.com_image_thumbnail_5542954e-1454-4885-9e54-7d37eeb27a45_size_174_quality_85_153edbb160a2d3b4744e43d5a2a9614f67d11ac8.jpg)
*Graphic depicts the thoracic aorta and great vessel origins.*

![Graphic depicts the branches of the descending thoracic aorta, including the intercostal, esophageal, and bronchial arteries. Typically, there are both superior and inferior left bronchial arteries and a single right bronchial artery (not pictured). Note that the left mainstem bronchus is bent anterior to allow depiction of the bronchial arteries.](images/app.statdx.com_image_thumbnail_4c42ea0a-88c0-47ec-bc0e-82243e8d9a3b_annotated_false_size_900_quality_90_6d383832fad8971555769b50c03ec9c1ccb39e97.jpg)
*Graphic depicts the branches of the descending thoracic aorta, including the intercostal, esophageal, and bronchial arteries. Typically, there are both superior and inferior left bronchial arteries and a single right bronchial artery (not pictured). Note that the left mainstem bronchus is bent anterior to allow depiction of the bronchial arteries.*


### Normal Anatomy of Thoracic Aorta and Great Vessels

![Frontal chest radiograph shows a normal thoracic aorta. The aortic knob shadow is created by a superimposition of the aortic arch and proximal descending aorta. The lateral margin of the descending thoracic aorta should always be visible, but the medial margin is usually not perceptible. The lateral margin of the ascending aorta is visible as part of the right mediastinal border.](images/app.statdx.com_image_thumbnail_04edb4d6-d53d-4f6b-ab7a-874b0f2ce459_annotated_false_size_900_quality_90_04a7835a23f8ed4c0a8560d3e9ea8a83c5d9ee61.jpg)
*Frontal chest radiograph shows a normal thoracic aorta. The aortic knob shadow is created by a superimposition of the aortic arch and proximal descending aorta. The lateral margin of the descending thoracic aorta should always be visible, but the medial margin is usually not perceptible. The lateral margin of the ascending aorta is visible as part of the right mediastinal border.*

![Corresponding frontal projection of a catheter angiogram (left) and digital subtraction image (right) of the thoracic aorta illustrate normal anatomy of the aorta and great vessel origins.](images/app.statdx.com_image_thumbnail_27246541-0d46-488a-87a0-32d2828be8b8_annotated_false_size_900_quality_90_2816740c880480ce86abea67fa3884c7675ab0ff.jpg)
*Corresponding frontal projection of a catheter angiogram (left) and digital subtraction image (right) of the thoracic aorta illustrate normal anatomy of the aorta and great vessel origins.*


### Aortic Root CT Anatomy

![&quot;Candy cane&quot; oblique MPR depicts the segments of the thoracic aorta. The aortic root (red) extends from the aortic anulus to the sinotubular junction. The ascending aorta (blue) extends to the origin of the brachiocephalic trunk. The aortic arch (yellow) extends to the ligamentum arteriosum. The descending thoracic aorta (green) extends to the diaphragmatic hiatus, where it continues as the abdominal aorta. Note the smooth outpouching along the inferior surface of the aortic arch at the remnant of the ductus arteriosum. This is a normal ductus diverticulum and should not be mistaken for a traumatic aortic injury.](images/app.statdx.com_image_thumbnail_f42a6503-b862-4f87-a1b0-f62c93448d4a_annotated_false_size_900_quality_90_702e62ceaff56bed3f1f73a568ff03ea292da9f2.jpg)
*&quot;Candy cane&quot; oblique MPR depicts the segments of the thoracic aorta. The aortic root (red) extends from the aortic anulus to the sinotubular junction. The ascending aorta (blue) extends to the origin of the brachiocephalic trunk. The aortic arch (yellow) extends to the ligamentum arteriosum. The descending thoracic aorta (green) extends to the diaphragmatic hiatus, where it continues as the abdominal aorta. Note the smooth outpouching along the inferior surface of the aortic arch at the remnant of the ductus arteriosum. This is a normal ductus diverticulum and should not be mistaken for a traumatic aortic injury.*

![&quot;Candy cane&quot; view of an MRA shows a thoracic aorta.](images/app.statdx.com_image_thumbnail_8ddca8b7-d0d8-4bef-b8e7-8cf96c7d1007_annotated_false_size_900_quality_90_b7e0218fa3dfbee179c04fe70a7a57dd82ade4bb.jpg)
*&quot;Candy cane&quot; view of an MRA shows a thoracic aorta.*

![Three-chamber view from a CT angiogram depicts the anatomy of the left ventricular outflow tract and aortic root.](images/app.statdx.com_image_thumbnail_58d1662b-e5f0-45d4-864e-28e51123a7ec_annotated_false_size_900_quality_90_dc6b7e477c2570fb19ea6bdba1e4a329eea72982.jpg)
*Three-chamber view from a CT angiogram depicts the anatomy of the left ventricular outflow tract and aortic root.*

![Graphic depicts the most common configuration of the aortic arch, the 3-vessel arch.](images/app.statdx.com_image_thumbnail_fe00cd5d-d1a0-400c-9456-f4c5137ebfbb_annotated_false_size_900_quality_90_738b9a070cdf066d74466163d5ac4810a522a7c9.jpg)
*Graphic depicts the most common configuration of the aortic arch, the 3-vessel arch.*

![Graphic depicts common aortic arch variants. In the most common variant (upper left), the brachiocephalic trunk and left common carotid artery share a common origin. In the 2nd most common variant (upper right), the left common carotid artery arises from the brachiocephalic trunk. The left vertebral artery may arise directly from the aortic arch (lower left), between the left common carotid and subclavian arteries. The aberrant right subclavian artery arises from the distal aortic arch after the takeoff of the left subclavian artery (lower right), courses behind the trachea and esophagus to the right, and therefore may cause dysphagia (termed dysphagia lusoria).](82ac9e2a-9e2a-43db-b7fe-8ce98e2ec245)
*Graphic depicts common aortic arch variants. In the most common variant (upper left), the brachiocephalic trunk and left common carotid artery share a common origin. In the 2nd most common variant (upper right), the left common carotid artery arises from the brachiocephalic trunk. The left vertebral artery may arise directly from the aortic arch (lower left), between the left common carotid and subclavian arteries. The aberrant right subclavian artery arises from the distal aortic arch after the takeoff of the left subclavian artery (lower right), courses behind the trachea and esophagus to the right, and therefore may cause dysphagia (termed dysphagia lusoria).*

![Digital subtraction catheter angiogram in the &quot;candy cane&quot; oblique view demonstrates 2 common aortic arch variants: Common origin of the brachiocephalic trunk and left common carotid (bovine arch) and a left vertebral artery arising directly from the aortic arch.](9ffa2036-fc9a-461d-a3bb-5af524a5f6fb)
*Digital subtraction catheter angiogram in the &quot;candy cane&quot; oblique view demonstrates 2 common aortic arch variants: Common origin of the brachiocephalic trunk and left common carotid (bovine arch) and a left vertebral artery arising directly from the aortic arch.*


### Standard Measurements

![Volume-rendered 3D CTA in &quot;candy cane&quot; view from a patient with a bicuspid aortic valve shows characteristic aneurysmal bowing of the ascending aorta. White lines denote standard aortic measurement planes, orthogonal to the long axis of the respective aortic segment. From proximal to distal, they include aortic anulus, sinus of Valsalva, sinotubular junction, ascending aorta at the level of the right pulmonary artery, aortic arch between the origins of the left subclavian and common carotid arteries, and the descending aorta.](ecd97b5c-bb48-4f3a-a51d-a2a158269170)
*Volume-rendered 3D CTA in &quot;candy cane&quot; view from a patient with a bicuspid aortic valve shows characteristic aneurysmal bowing of the ascending aorta. White lines denote standard aortic measurement planes, orthogonal to the long axis of the respective aortic segment. From proximal to distal, they include aortic anulus, sinus of Valsalva, sinotubular junction, ascending aorta at the level of the right pulmonary artery, aortic arch between the origins of the left subclavian and common carotid arteries, and the descending aorta.*

![Multiplanar reformation of the aortic anulus shows the typical ovoid shape of the anulus. Accurate measurement of the anulus is important for sizing aortic valve replacements. Long- and short-axis diameters are reported. Annular circumference and area may also be helpful.](1189cba1-ab18-443c-a33e-dc51b121a559)
*Multiplanar reformation of the aortic anulus shows the typical ovoid shape of the anulus. Accurate measurement of the anulus is important for sizing aortic valve replacements. Long- and short-axis diameters are reported. Annular circumference and area may also be helpful.*

![Image immediately above the aortic anulus depicts portions of the aortic valve cusps. The anulus is measured as a virtual ring defined by the attachment of the lowest points of each aortic cusp.](f6c468c1-be0e-45f9-9404-58ec0e61840b)
*Image immediately above the aortic anulus depicts portions of the aortic valve cusps. The anulus is measured as a virtual ring defined by the attachment of the lowest points of each aortic cusp.*


### Aortic Root Short-Axis Planes

![Multiplanar reformat through the sinus of Valsalva is shown. The sinus of Valsalva diameters are measured from commissure to cusp. Note that the interatrial septum points toward the noncoronary cusp in all projections. Inset shows the 3 diameter measurements (commissure to contralateral sinus) obtained in this plane.](e57e6380-007d-432d-b8ca-e124b7b71932)
*Multiplanar reformat through the sinus of Valsalva is shown. The sinus of Valsalva diameters are measured from commissure to cusp. Note that the interatrial septum points toward the noncoronary cusp in all projections. Inset shows the 3 diameter measurements (commissure to contralateral sinus) obtained in this plane.*

![Oblique MIP through the sinus of Valsalva depicts the coronary origins.](2663f359-ae0d-4757-949c-8f75186a524f)
*Oblique MIP through the sinus of Valsalva depicts the coronary origins.*

![Oblique MPR, orthogonal to the aorta at the level of the sinotubular junction, shows that the sinotubular junction is of lower caliber than the sinus of Valsalva. Aortic diameters are most accurately and reproducibly measured in the plane orthogonal to the centerline of the aorta.](f25ab882-3138-417e-b0dc-d5fd9d46213a)
*Oblique MPR, orthogonal to the aorta at the level of the sinotubular junction, shows that the sinotubular junction is of lower caliber than the sinus of Valsalva. Aortic diameters are most accurately and reproducibly measured in the plane orthogonal to the centerline of the aorta.*


### Standard Planes of Aorta

![Axial CT at the level of the right pulmonary artery shows the ascending and descending aorta. The ascending aorta is often greatest in diameter and nearly orthogonal to the axial plane at this level.](1a173007-1b8c-43f4-a0ac-a3c05bb70c96)
*Axial CT at the level of the right pulmonary artery shows the ascending and descending aorta. The ascending aorta is often greatest in diameter and nearly orthogonal to the axial plane at this level.*

![MPR orthogonal to the aortic long axis at the level of the aortic arch, between the origins of the left common carotid and left subclavian arteries, is the standard plane for aortic arch diameter measurement.](7c6f7fd5-848d-4aee-a34a-490f059b719b)
*MPR orthogonal to the aortic long axis at the level of the aortic arch, between the origins of the left common carotid and left subclavian arteries, is the standard plane for aortic arch diameter measurement.*

![Oblique MIP in C view depicts the course of the right coronary artery and the origins of the left and right coronary arteries from the sinus of Valsalva.](2b73c10d-7009-424e-9ed2-70268001f7c2)
*Oblique MIP in C view depicts the course of the right coronary artery and the origins of the left and right coronary arteries from the sinus of Valsalva.*


### TAVI/R Planning

![Curved multiplanar reformation high-pitch gated CTA shows the entire aorta and left iliofemoral system (right). Coned-down lateral radiograph shows a transcatheter aortic valve replacement (TAVR) (upper left inset). CTA is increasingly used for TAVR planning. The dimensions of the aortic anulus (mid left inset) are critical for valve sizing. The minimum luminal diameter of the iliofemoral arteries (lower left inset) and the degree of tortuosity and calcification of the aorta and iliofemoral system (right) determine whether a transfemoral approach is possible.](e19b642d-f2c1-4105-9878-8b868633bc51)
*Curved multiplanar reformation high-pitch gated CTA shows the entire aorta and left iliofemoral system (right). Coned-down lateral radiograph shows a transcatheter aortic valve replacement (TAVR) (upper left inset). CTA is increasingly used for TAVR planning. The dimensions of the aortic anulus (mid left inset) are critical for valve sizing. The minimum luminal diameter of the iliofemoral arteries (lower left inset) and the degree of tortuosity and calcification of the aorta and iliofemoral system (right) determine whether a transfemoral approach is possible.*

![Oblique MIP depicts the coronary artery origins. Obstruction of the coronary ostia by displaced aortic valve leaflets is an infrequent but reported complication of TAVR, so the distance from the aortic anulus plane (yellow line) to the closest coronary ostium is provided. In this case, the distance to the right coronary ostium corresponds to the double-headed black arrow.](4f98fa0f-6466-49ba-a513-1fbd2ae0baa0)
*Oblique MIP depicts the coronary artery origins. Obstruction of the coronary ostia by displaced aortic valve leaflets is an infrequent but reported complication of TAVR, so the distance from the aortic anulus plane (yellow line) to the closest coronary ostium is provided. In this case, the distance to the right coronary ostium corresponds to the double-headed black arrow.*