Transcatheter aortic valve replacement (TAVR) is a rapidly expanding alternative to surgical aortic valve replacement for patients deemed inoperable or at high or intermediate operative risk. Yet, residual aortic regurgitation (AR) secondary to paravalvular leaks (PVL) remains a procedural limitation. Although residual AR after TAVR is frequent, affecting up to approximately 70% of the treated patients,^– it is moderate to severe in approximately 12% of these and steadily below 5% with current-generation devices, which come with specific sealing features. Noteworthy, moderate/severe AR has a detrimental clinical impact after TAVR, with a 3-fold increase in 30-day mortality and a 2.3-fold increase in 1-year mortality. Thus, its accurate assessment and quantification with a multimodality approach is key for appropriate utilization of additional procedures to reduce PVL, such as balloon post-dilatation (BPD), valve-in-valve, or leak closure.^,

While Doppler echocardiography has been the most common method to assess AR following TAVR, its accurate quantification is challenging since AR jets are often multiple and eccentric.^,– Therefore, other methods for proper AR assessment have been evaluated in recent years, such as 3D echocardiography, hemodynamic AR index, aortography and even cardiovascular magnetic resonance, each one with its specific advantages and disadvantages.^,,

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