Proximal isovelocity surface area

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Synonyms and related keywords: PISA

Overview

The proximal isovelocity surface area (PISA) technique can be used to estimate the flow across the regurgitant valve together with the Effective Regurgitant Orifice Area (EROA).

The technique is an application of the continuity principle with the underlying assumption being that the flow at the hemispheric first alias proximal surface is equal to the orificial flow at the same time in the cardiac cycle.

In order to measure these indices of regurgitation it is necessary to perform both continuous wave Doppler (CWD) and colour Doppler analyses of representative cardiac cycles.

Vmax (the peak velocity of the regurgitant flow signal) is measured with CWD.

Colour Doppler is then used to measure the radius (RA1) of the first aliased hemispheric shell at a Nyquist limit (Scale Value) typically in the range 30 - 40 cm/sec (VN). ^{[1] [1]}

Typical values of PISA radius (at VN of 38 cm/sec) for mitral regurgitation of differing severity are:

• Grade PISA Radius(mm)
• Mild: < 3.5
• Moderate: 3.5 - 7.5
• Moderately Severe: 7.5 - 14.5
• Severe: > 14.5

Typical values of PISA Flow for mitral regurgitation of differing severity are:

• Grade PISA Q
• Mild: < 30 ml/sec
• Moderate: 30 - 130 ml/sec
• Moderately Severe: 130 - 500 ml/sec
• Severe: > 500 ml/sec

Typical values of EROA for mitral regurgitation of differing severity are:

• Grade EROA(mm2)
• Mild: < 20
• Moderate: 20 - 29
• Moderately Severe: 30 - 39
• Severe: > 40

According to Kolev et al, the PISA technique may be particularly appropriate for the estimation of the severity of mitral regurgitation in the patient with an eccentric regurgitant jet.

How to Calculate PISA?

1. Shift Aliasing velocity to 40 cm/sec
2. Cine to mid systole
3. Measure radius (cm)
4. Calculate r2/ 2 to get ERO
5. To Calculate Volume (cc) ERO x TVI of mitral valve

References

External Link

• Duke University Echo Learning Center

v • d • e WikiDoc Research Resources for Proximal isovelocity surface area
Articles on Proximal isovelocity surface area	Most recent articles on Proximal isovelocity surface area • Most cited articles on Proximal isovelocity surface area • Review articles on Proximal isovelocity surface area • Articles on Proximal isovelocity surface area in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Proximal isovelocity surface area	Powerpoint slides on Proximal isovelocity surface area • Images of Proximal isovelocity surface area • Photos of Proximal isovelocity surface area • Podcasts & MP3s on Proximal isovelocity surface area • Videos on Proximal isovelocity surface area
Evidence Based Medicine Regarding Proximal isovelocity surface area	Cochrane Collaboration on Proximal isovelocity surface area • Bandolier on Proximal isovelocity surface area • TRIP on Proximal isovelocity surface area
Cost Effectiveness of Proximal isovelocity surface area	Cost Effectiveness of Proximal isovelocity surface area
Clinical Trials Involving Proximal isovelocity surface area	Ongoing Trials on Proximal isovelocity surface area at Clinical Trials.gov • Trial results on Proximal isovelocity surface area • Clinical Trials on Proximal isovelocity surface area at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Proximal isovelocity surface area	US National Guidelines Clearinghouse on Proximal isovelocity surface area • NICE Guidance on Proximal isovelocity surface area • NHS PRODIGY Guidance • FDA on Proximal isovelocity surface area • CDC on Proximal isovelocity surface area
Textbook Information on Proximal isovelocity surface area	Books and Textbook Information on Proximal isovelocity surface area
Pharmacology Resources on Proximal isovelocity surface area	Dosing of Proximal isovelocity surface area • Drug interactions with Proximal isovelocity surface area • Side effects of Proximal isovelocity surface area • Allergic reactions to Proximal isovelocity surface area • Overdose information on Proximal isovelocity surface area • Carcinogenicity information on Proximal isovelocity surface area • Proximal isovelocity surface area in pregnancy • Pharmacokinetics of Proximal isovelocity surface area •
Genetics, Pharmacogenomics, and Proteinomics of Proximal isovelocity surface area	Genetics of Proximal isovelocity surface area • Pharmacogenomics of Proximal isovelocity surface area • Proteomics of Proximal isovelocity surface area
Newstories on Proximal isovelocity surface area	Proximal isovelocity surface area in the news • Be alerted to news on Proximal isovelocity surface area • News trends on Proximal isovelocity surface area
Commentary on Proximal isovelocity surface area	Blogs on Proximal isovelocity surface area
Patient Resources on Proximal isovelocity surface area	Patient resources on Proximal isovelocity surface area • Discussion groups on Proximal isovelocity surface area • Patient Handouts on Proximal isovelocity surface area • Directions to Hospitals Treating Proximal isovelocity surface area • Risk calculators and risk factors for Proximal isovelocity surface area
Healthcare Provider Resources on Proximal isovelocity surface area	Symptoms of Proximal isovelocity surface area • Causes & Risk Factors for Proximal isovelocity surface area • Diagnostic studies for Proximal isovelocity surface area • Treatment of Proximal isovelocity surface area
Continuing Medical Education (CME) Programs on Proximal isovelocity surface area	CME Programs on Proximal isovelocity surface area
International Resources on Proximal isovelocity surface area	Proximal isovelocity surface area en Espanol • Proximal isovelocity surface area en Francais
Business Resources on Proximal isovelocity surface area	Proximal isovelocity surface area in the Marketplace • Patents on Proximal isovelocity surface area
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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .