Explaining the Emory TMVR angle. Discordance between mitral annular centerline (yellow lines) and valve orientation imposed by guidewire position within the LV apex (red dashed lines). (B) Valve intrinsic angle (α) is determined by external skirt height. (C) When annular-apical “Emory” angle (red curves) exceeds α (blue curve), annular skirt apposition is not possible, causing PVL (red arrows). (D) The valve is oriented perpendicular to the annual plane using an exteriorized apical guidewire (solid yellow line). Image courtesy of Kendra Grubb, M.D. Feature | Structural Heart | May 13, 2021 | By Dave Fornell, Editor