Document Detail


The "proximal isovelocity surface area" method in assessing mitral valve area in patients with mitral stenosis and associated aortic regurgitation.
MedLine Citation:
PMID:  9199948     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This study compares the mitral valve area determined by Doppler color mapping of the proximal isovelocity surface area (PISA) and by Doppler pressure half-time with that obtained by two-dimensional planimetry in patients affected by mitral stenosis, with and without associated aortic regurgitation. Pressure half-time frequently overestimates the mitral valve area in patients with mitral stenosis and associated aortic regurgitation. PISA is an alternative method for determining mitral valve area in mitral stenosis and is not influenced by regurgitant lesions. METHODS: We studied 76 patients with mitral stenosis; aortic regurgitation > or = 2 was present in 24 patients. The PISA was recorded from the apex and the transmitral maximal flow rate, Q (ml/s), was calculated using the hemispheric equation Q = 2 pi R2 x AV x alpha/180, where R (cm) is the maximal radius of the PISA, AV (cm/s) is the aliasing velocity and alpha/180 is a correction factor accounting for the alpha inflow angle formed by the mitral leaflets. Mitral valve area, A (cm2), was calculated by continuity equation A = Q/V, where V (cm/s) is the peak transmitral flow velocity measured by continuous wave Doppler. RESULTS: The mitral valve area by two-dimensional planimetry (range 0.5-2.4 cm2; mean 1.33 +/- 0.41 cm2) was consistent with both PISA (r = 0.83; SEE 0.23 cm2) and pressure half-time (r = 0.79; SEE 0.25 cm2) methods. Similar agreement was found for the 36 patients with mitral regurgitation and for the 30 patients in atrial fibrillation. However, in patients with aortic regurgitation > or = 2, pressure half-time overestimated two-dimensional and PISA determined mitral valve areas by 0.24 +/- 0.25 cm2 (p < 0.01). CONCLUSIONS: In patients with mitral stenosis and significant aortic regurgitation, the PISA method is more accurate than pressure half-time in assessing mitral valve area. This method may be a reliable alternative when pressure half-time is affected by aortic regurgitation and two-dimensional planimetry images are unsuitable for anatomic evaluation.
Authors:
G Centamore; A R Galassi; R Evola; L Lupo; A Galassi
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Giornale italiano di cardiologia     Volume:  27     ISSN:  0046-5968     ISO Abbreviation:  G Ital Cardiol     Publication Date:  1997 Feb 
Date Detail:
Created Date:  1997-08-01     Completed Date:  1997-08-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1270331     Medline TA:  G Ital Cardiol     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  133-40     Citation Subset:  IM    
Affiliation:
Divisione di Cardiologia Azienda Ospedaliera Cannizzaro, Catania.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aortic Valve Insufficiency / ultrasonography*
Atrial Fibrillation / physiopathology,  ultrasonography
Echocardiography
Echocardiography, Doppler, Color
Electrocardiography
Female
Humans
Male
Middle Aged
Mitral Valve / ultrasonography*
Mitral Valve Stenosis / ultrasonography*
Observer Variation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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