J Korean Soc Echocardiogr.  1994 Jul;2(1):41-52. 10.4250/jkse.1994.2.1.41.

Quantitative Evaluation of Regurgitant Volume in the Patients with Mitral Regurgitation Using Color Doppler Proximal Isovelocity Surface Area Method

• Kang HS
• Choue CW
• Kim KS
• Kim MS
• Song JS
• Bae JH

• KMID: 2410458
• DOI: http://doi.org/10.4250/jkse.1994.2.1.41

Abstract

BACKGROUND
The Evaluation of valvular regurgitation is a long standing clinical problem. While many ways to evaluate the severity of valvular insufficiency have been tried, none allows precise quantification of regurgitation volume. Invasive angiographic grading of mitral regurgitation is semiquantitative and subjective. Recent studies have shown that using color Doppler flow mapping can identify a blue-red aliasing radius, corresponding to a proximal isovelocity surface area(PISA), proximal to a regurgitant orifice. Thus regurgitant volume across the mitral orifice can be calculated.
METHODS
The clinical applicability of the PISA method was evaluated prospectively in 23 patients with mitral regurgitation and also the regurgitant volume calculated by using the time-velocity integral(TVI) method. The regurgitant jet area were compared to regurgitant volume calculated from the PISA method.
RESULTS
1) Regurgitant volume calculated by using the PISA method correlated well with the regurgitant volume calculated by using the TVI method(r=0.73, P=0.0001). 2) Regurgitant volume calculated by using the PISA method did not correlate with the regurgitant jet to left atrial ratio(r=-0.02, P=0.94). 3) Eccentricity of regurgitant flow did not influence the result of PISA method.
CONCLUSIONS
It is concluded that PISA method by color Doppler flow imaging is simple and useful noninvasive method for the quantitative evaluation of mitral regurgitant volume.

Keyword

PISA method; Mitral regurgitant volume

MeSH Terms

Evaluation Studies as Topic*
Humans
Methods*
Mitral Valve Insufficiency*
Prospective Studies
Radius

Figure

• 

  Fig. 1. PISA의 원리: 좁은 줄구로 황하는 혈류는 점차빠른 속도로 집종되어 반구형태의 돌속면올이룬다. 이 동속면상으| flow rate(PISA × velocity)는 좁은 줄구를 통한 flow rate(Regurgitantfow)와 같다

• 

  Fig. 2. Color Doppler systolic image in a patient with severe mitral regurgitation. Proximal isovelocity surface area (arrow) is clearly visible proximal to the mitral valve orifice.

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  Fig. 3-1. Illustration of quantitative Doppler measurements by time-velocty interal method. Pannel A: Parasternal long-axis view: measurement of the length at the left ventricular outflow tract (LVOT), Pannel B: Apical long-axis view: position of the sample volume(closed box) at LVOT, Pannel C: Apical four-chamber view: measurement of the length at the mitral annulus, Pannel D: Apical four-chamber view: position of the sample volume(closed box) at the mid portion of mitral annulus.

• 

  Fig. 3-2. Continued Figure 3-1. Pannel A: Pulsed-wave Doppler image at the LVOT Pannel B: Pulsed-wave Doppler image at the mitral annulus.

Reference

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