title: Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation.
abstract: Effective regurgitant orifice area is a useful index of the severity of mitral regurgitation (MR). The calculation of regurgitant orifice area using the proximal isovelocity surface area (PISA) method has some technical limitations. Three-dimensional reconstruction of the MR jet was performed using the Live 3D system on a Sonos 7500 to measure regurgitant orifice area directly in 109 cases of MR. Regurgitant orifice area was also measured by quantitative 2-dimensional echocardiography and by the PISA method. To analyze the shape of the regurgitant orifice, the ratio of the long axis to the short axis of the orifice (the L/S ratio) was calculated. Regurgitant orifice area on 3-dimensional echocardiography showed an almost identical correlation with that obtained by quantitative echocardiography (r = 0.91, p <0.0001, slope = 0.97) regardless of the L/S ratio. It was also significantly correlated with orifice area obtained using the PISA method (r = 0.93, p <0.0001). However, orifice area on 3-dimensional echocardiography was significantly larger than that obtained using the PISA method in the whole study group and in the 62 cases of MR with L/S ratios >1.5, whereas the correlation was almost identical in cases of MR with L/S ratios < or =1.5. Orifice area obtained using the PISA method also underestimated that obtained by quantitative echocardiography in cases of MR with L/S ratios >1.5. Three-dimensional echocardiography provided robust values independent of the eccentricity of the MR jet or of cardiac rhythm. In conclusion, the direct measurement of the regurgitant orifice area of MR with 3-dimensional Doppler echocardiography could be a promising method to overcome the limitations of the PISA method, especially in cases of MR with elliptic orifice shapes.
authors.affiliation: Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan. iwakura@mac.com
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Iwakura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Shigeo
authors.initials: S
authors.lastname: Kawano
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okamura
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kurotobi
authors.forename: Motoo
authors.initials: M
authors.lastname: Date
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D018450:Disease Progression; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009200:Myocardial Contraction / Q000502:physiology; D011379:Prognosis; D012720:Severity of Illness Index