Hemisphere versus hemiellipse: when is each most accurate for proximal isovelocity calculation of regurgitant flows

Buck, Tahisha M.; Jansen, Carl; Yoganathan, A.P.; Levine, Robert A.; Handschumacher, Mark D.

doi:10.1016/s0735-1097(98)80025-9

Cited by 4 publications

(2 citation statements)

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“…These modifications could be either a multiplane evaluation of the PISA shape or a direct three-dimensional (3D) quantification. [13][14][15][16] However, calculations require many measurements or an offline analysis, which can be timeconsuming, making it difficult to perform in clinical practice. The aim of this study was to test in vitro, with an in vivo validation, the accuracy of the PISA method depending on the shape and number of regurgitant flows, as well as the modification of the formula, allowing for a more precise assessment with simple and accessible measurements.…”

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confidence: 99%

In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method

Papolla

Adda

Rique

et al. 2020

Journal of the American Society of Echocardiography

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Background: Doppler echocardiographic methods, such as the proximal isovelocity surface area (PISA) method, are used to quantify mitral regurgitations (MRs). However, their accuracy and reproducibility are still being discussed, especially in the case of MR of complex geometry. The aim of this study was to evaluate the accuracy of the PISA method depending on the shape and number of regurgitant flows.Methods: First, various MR shapes and severities (central, oblong, and multiple-jet MR) were mimicked in a left heart simulator. The effective regurgitant orifice area (EROA) was calculated using the standard and modified PISA methods and was compared to a reference value obtained from an electromagnetic flowmeter. Second, in order to clinically validate the in vitro findings, 16 patients were examined with two-dimensional (2D) echocardiography. The results were analyzed by comparing the PISA method and the echocardiographic 2D quantitative volumetric method.Results: Both hemicylindrical and hemiellipsoidal PISA assumptions improved the quantification of the EROA for oblong MR compared with the traditional PISA method (hemispherical PISA assumption: 11 6 4.6 mm 2 , P < .01; hemicylindrical PISA assumption: 2 6 0.8 mm 2 , P = .83; hemiellipsoidal PISA assumption: 6 6 3.7 mm 2 , P = .05). In the case of multiple jets of different sizes, an improved EROA calculation was measured when both jets were considered (single hemispherical PISA assumption: 4.5 6 0.7 mm 2 , P < .01; double hemispherical PISA assumption: 2 6 1.1 mm 2 , P = .64). Conclusion:For a correct diagnosis of MR, the PISA geometry must be considered. A measurement of both PISA radius and PISA width is necessary for an accurate quantification of an oblong MR. In the case of a double-jet MR, a measurement of the two radii is recommended.

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confidence: 99%

In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method

Papolla

Adda

Rique

et al. 2020

Journal of the American Society of Echocardiography

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“…It may underestimate the severity of MR if inappropriate assumptions are chosen. 5,17,23 Although its formula is further improved for specific MR geometries (oblong MR, multiple jets MR), 25,42 the PISA method is mainly based on a valve evaluation.…”

Section: Clinical Impact: See Beyond the Mitral Valvementioning

confidence: 99%

Impact of Mitral Regurgitation on the Flow in a Model of a Left Ventricle

Papolla

Darwish

Kadem

et al. 2020

Cardiovasc Eng Tech

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Purpose-Mitral regurgitation (MR) is the second most common valve disease in industrialized countries. Despite its high prevalence, little is known about its impact on the flow dynamics in the left ventricle (LV). Because of the interdependence between valvular function and hemodynamics in the heart chambers, an exploration of the dynamics in the LV could lead to a diagnosis of MR. This in vitro study aimed to develop an advanced left heart simulator capable of reproducing several conditions of MR and to evaluate their impact on the LV flow dynamics in terms of flow structures and viscous energy dissipation (VED). Methods-A simulator, previously developed to test mechanical and biological valves, was upgraded with an original anatomically-shaped mitral valve made from a hydrogel. The valve can be used in healthy or pathological configurations. The nature and severity of the disease was controlled by applying specific strain to the chordae. In this study, in addition to a healthy condition, two different severities of MR were investigated: moderate MR and severe MR. Planar time-resolved particle image velocimetry measurements were performed in order to evaluate the velocity field in the LV and the VED induced by each condition. Results-Our results showed that MR led to flow disturbances in the LV that were characterized by an increase in mitral inflow velocity and by elevated values of VED. Interestingly VED increased in proportion to the severity of MR and with a dissipation predominating during systole. Conclusion-Considering these results, the introduction of new parameters based on LV VED could provide crucial information regarding the coupling between the mitral valve and the LV and allow for a better stratification of patients with MR.

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Direct Assessment of Size and Shape of Noncircular Vena Contracta Area in Functional Versus Organic Mitral Regurgitation Using Real-Time Three-Dimensional Echocardiography

Kahlert¹,

Plicht²,

Schenk³

et al. 2008

Journal of the American Society of Echocardiography

181

135

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Hemisphere versus hemiellipse: when is each most accurate for proximal isovelocity calculation of regurgitant flows

Cited by 4 publications

References 0 publications

In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method

In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method

Impact of Mitral Regurgitation on the Flow in a Model of a Left Ventricle

Direct Assessment of Size and Shape of Noncircular Vena Contracta Area in Functional Versus Organic Mitral Regurgitation Using Real-Time Three-Dimensional Echocardiography

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