Orlando Deffer, MD

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PISA

• Orlando Deffer, MD

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• PISA and its hydrodynamic principle.
• Calculation EROA 6.28rsqxVa/PKreg
• Measurement of PISA by color flow mapping
  requires adjustment of the aliasing velocity such
  that a well hemisphere is shown.

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• Limitations-
• More accurate for central jets and for
  regurgitation with a circular orifice
• Difficulty in judging the precise location of
  the orifice and the flow convergance shape.
• Recent modifications of the described PISA
  method use the distance between two aliasing
  contours

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• PISA
• Much less experience exists for assessment of
  AR compared to MR
• ECHO is performed from the apical, para-apical
  views, or the upper right-sternal border, with
  images zoomed on the valvular and supravalvular
  region. Due to interposition of valve tissue its
  less feasible than MR

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• Pitfalls-
• Difficult in obtaining high quality images of
  the flow convergance region.
• Timing of measurement of the flow convergance
  radius, which should be in early diastole,
  closest to the peak regurgitant velocity.
• Ascending aortic aneurysms, which deform the
  valvular plane, may lead to underestimation of AR
  by this method. Thresholds for severe AR are an
  EROAgt0.3cmsq or RVgt60ml.

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