TY - JOUR
T1 - Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography
T2 - Difference between functional mitral regurgitation and prolapse regurgitation
AU - Matsumura, Yoshiki
AU - Fukuda, Shota
AU - Tran, Hung
AU - Greenberg, Neil L.
AU - Agler, Deborah A.
AU - Wada, Nozomi
AU - Toyono, Manatomo
AU - Thomas, James D.
AU - Shiota, Takahiro
N1 - Funding Information:
This study was supported in part by the National Space Biomedical Research Institute through NASA NCC 9-58 (Houston, TX), the Department of Defense (Fort Dietrich, MD, USAMRMC Grant #02360007), and an equipment grant from General Electric (Milwaukee, WI).
Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2008/2
Y1 - 2008/2
N2 - Background: The geometry of the proximal isovelocity surface area (PISA) of functional mitral regurgitation (MR), which is conventionally assumed to be a hemisphere, remains to be clarified. We investigated the 3-dimensional (3D) geometry of PISA of functional MR as opposed to that of MR due to mitral valve prolapse (MVP) by real-time 3D echocardiography with color Doppler capability. Methods: Twenty-seven patients with functional MR and 27 patients with MVP were examined. The horizontal PISA length in the commissure-commissure plane and each PISA radius in 3 anteroposterior planes (medial, central, and lateral) were measured by real-time 3D echocardiography with 3D software. The effective regurgitant orifice (ERO) area was calculated with the maximum PISA radius and compared to that by 2D quantitative Doppler method. Results: En-face 3D color Doppler images showed an elongated and slightly curved PISA geometry along the leaflet coaptation in functional MR, whereas the geometry was rounder in MVP. The PISA horizontal length in functional MR was longer than that in MVP (2.3 ± 0.4 vs 1.2 ± 0.2 cm, P < .001). The PISA method with the maximum radius underestimated the ERO area by 2D quantitative Doppler method (by 24%) in functional MR, but not in MVP. Conclusions: The geometry of PISA in functional MR was elongated, distinctly different from the more focal pathology of MVP, leading to underestimation of the ERO area by PISA method.
AB - Background: The geometry of the proximal isovelocity surface area (PISA) of functional mitral regurgitation (MR), which is conventionally assumed to be a hemisphere, remains to be clarified. We investigated the 3-dimensional (3D) geometry of PISA of functional MR as opposed to that of MR due to mitral valve prolapse (MVP) by real-time 3D echocardiography with color Doppler capability. Methods: Twenty-seven patients with functional MR and 27 patients with MVP were examined. The horizontal PISA length in the commissure-commissure plane and each PISA radius in 3 anteroposterior planes (medial, central, and lateral) were measured by real-time 3D echocardiography with 3D software. The effective regurgitant orifice (ERO) area was calculated with the maximum PISA radius and compared to that by 2D quantitative Doppler method. Results: En-face 3D color Doppler images showed an elongated and slightly curved PISA geometry along the leaflet coaptation in functional MR, whereas the geometry was rounder in MVP. The PISA horizontal length in functional MR was longer than that in MVP (2.3 ± 0.4 vs 1.2 ± 0.2 cm, P < .001). The PISA method with the maximum radius underestimated the ERO area by 2D quantitative Doppler method (by 24%) in functional MR, but not in MVP. Conclusions: The geometry of PISA in functional MR was elongated, distinctly different from the more focal pathology of MVP, leading to underestimation of the ERO area by PISA method.
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U2 - 10.1016/j.ahj.2007.09.002
DO - 10.1016/j.ahj.2007.09.002
M3 - Article
C2 - 18215591
AN - SCOPUS:38149008090
VL - 155
SP - 231
EP - 238
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 2
ER -