{"id":28,"date":"2008-09-30T06:09:47","date_gmt":"2008-09-30T06:09:47","guid":{"rendered":"http:\/\/cardiophile.org\/?p=28"},"modified":"2008-09-30T06:09:47","modified_gmt":"2008-09-30T06:09:47","slug":"proximal-isovelocity-surface-area-pisa-method-for-estimation-of-mitral-regurgitation","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/proximal-isovelocity-surface-area-pisa-method-for-estimation-of-mitral-regurgitation\/","title":{"rendered":"Proximal Isovelocity Surface Area (PISA) method for estimation of mitral regurgitation"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Proximal Isovelocity Surface Area (PISA) method for estimation of mitral regurgitation<\/span><\/h2>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/KiMA7XKO_io\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><br \/>\n<span style=\"color: #ff00ff;\">Proximal Isovelocity Surface Area (PISA) method is based on the continuity equation.<\/span> When a flow passes through a narrow orifice, as it approaches the narrowest region, there is a flow convergence and flow acceleration. <span style=\"color: #0000ff;\">PISA is the surface area of the hemisphere at the aliasing region of the flow convergence [1]<\/span>. PISA increases as the flow increases and also with lower aliasing velocity. <span style=\"color: #008000;\">To reduce errors in measurement, smaller aliasing velocity has to be set, to get higher PISA measurement with lower chance for errors.<\/span><\/p>\n<p><strong><span style=\"color: #0000ff;\">Regurgitant flow rate can be calculated as:<\/span><\/strong><\/p>\n<p><span style=\"color: #ff00ff;\">2\u03c0r<sup>2<\/sup> x V<sub>aliasing<\/sub><\/span><\/p>\n<p>Radius is measured from the orifice to point of colour change. If the flow convergence is not a true hemisphere, the angle subtended by the flow convergence at the orifice has to be measured and divided by 180 to get a correction factor. Good correlation between angiographic estimates of regurgitant flow and PISA based estimates have been reported.<\/p>\n<p>PISA method has been used for intraoperative assessment of severity of mitral regurgitation. It provides a quantitative assessment of severity of MR and is useful in clinical decision making in the operating room [1].&nbsp;Effective regurgitant orifice, regurgitant volume and regurgitant fraction can also be calculated using the PISA method.<\/p>\n<p>Effective regurgitant orifice area will be <span style=\"color: #ff00ff;\">(2\u03c0r<sup>2<\/sup> x Nyquist limit)\/V<sub>max<\/sub><\/span>. V<sub>max<\/sub> is the maximum velocity of the mitral regurgitation get measured by continuous wave (CW) Doppler.&nbsp;Regurgitant volume will be effective regurgitant orifice area multiplied by the velocity time integral (VTI) of the MR jet.&nbsp;Regurgitant fraction is calculated as the ratio of regurgitant volume to total stroke volume [1].<\/p>\n<p><strong><span style=\"color: #0000ff;\">Limitations of PISA method<\/span><\/strong><\/p>\n<ol>\n<li>Dynamic changes in orifice<\/li>\n<li>Oval or irregular regurgitant orifice<\/li>\n<li>Non optimal flow convergence<\/li>\n<li>Not useful when there are multiple regurgitant orifices<\/li>\n<\/ol>\n<p>Hemielliptic proximal isovelocity surface area method has been suggested for more accurate quantification of mitral regurgitation by PISA method [2]. Another method to overcome the variation in shape of PISA from a true hemisphere is three dimensional echocardiography. In a pediatric population, it was found that PISA is rarely hemispherical, but more often prolate or oblate hemispheroid [3].<\/p>\n<p><strong><span style=\"color: #0000ff;\">References<\/span><\/strong><\/p>\n<ol>\n<li>Lambert AS. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17898369\/\">Proximal isovelocity surface area should be routinely measured in evaluating mitral regurgitation: a core review<\/a>. Anesth Analg. 2007 Oct;105(4):940-3.<\/li>\n<li>Fujii H, Kibira S, Izumi C, Saito T, Ryabikov A, Miura M. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11548883\/\">Hemielliptic proximal isovelocity surface area method modified for clinical application: more accurate quantification of mitral regurgitation in Doppler echocardiography<\/a>. Jpn Circ J. 2001 Sep;65(9):820-6.<\/li>\n<li>Ziani AB, Latcu DG, Abadir S, Paranon S, Dulac Y, Guerrero F, Acar P. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19375672\/\">Assessment of proximal isovelocity surface area (PISA) shape using three-dimensional echocardiography in a paediatric population with mitral regurgitation or ventricular shunt<\/a>. Arch Cardiovasc Dis. 2009 Mar;102(3):185-91.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Proximal Isovelocity Surface Area (PISA) method for estimation of mitral regurgitation<\/p>\n","protected":false},"author":1,"featured_media":38295,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[8],"tags":[],"class_list":["post-28","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-echocardiogram-library"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Proximal Isovelocity Surface Area method for estimation of MR<\/title>\n<meta name=\"description\" content=\"Proximal Isovelocity Surface Area (PISA) method for estimation of mitral regurgitation\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, 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