title: Clinical usefulness of the effective regurgitant orifice area determined by transesophageal echocardiography in patients with eccentric aortic regurgitation.
abstract: OBJECTIVE
  The aortic regurgitant jet is frequently eccentric, and Doppler color flow mapping techniques of the distal jet is influenced by this eccentricity. The aim of the present study was to determine whether the effective regurgitant orifice area (EROA), determined by the proximal isovelocity surface area (PISA) method using multiplane transesophageal echocardiography (m-TEE), could be used to evaluate the severity of aortic regurgitation (AR) in patients with an eccentric jet.
  
  
  METHODS
  Forty-eight patients with eccentric AR were studied. Values of EROA determined by the PISA method were compared with results from cross-sectional area (CSA), vena contracta (VC) width, aortic angiography, and regurgitant fraction.
  
  
  RESULTS
  Values of EROA correlated well with results from CSA (r = 0.73, p < 0.001), VC (r = 0.74, p < 0.001), angiographic grade (rs = 0.90 p < 0.001), and regurgitant fraction (r = 0.84, p < 0.001) in patients with eccentric aortic regurgitation. Values of EROA > 0.27 cm2 were always associated with a regurgitant fraction > 0.4, while EROA values < 0.27 cm2 were always associated with a regurgitant fraction < 0.4.
  
  
  CONCLUSIONS
  We conclude that, in patients with an eccentric jet, measurement of EROA values by the PISA method using m-TEE is a reliable method of assessing the severity of AR.
authors.affiliation: Third Department of Surgery, Iwate Medical University, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: K
authors.initials: K
authors.lastname: Kawazoe
authors.forename: J
authors.initials: J
authors.lastname: Kamata
authors.forename: H
authors.initials: H
authors.lastname: Izumoto
authors.forename: H
authors.initials: H
authors.lastname: Kitahara
authors.forename: K
authors.initials: K
authors.lastname: Tasai
authors.forename: K
authors.initials: K
authors.lastname: Eishi
authors.forename: K
authors.initials: K
authors.lastname: Nakai
authors.forename: M
authors.initials: M
authors.lastname: Nasu
authors.forename: K
authors.initials: K
authors.lastname: Hiramori
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000502:physiology; D002932:Cineangiography; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index