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Anesth Analg 2007; 105:940-943
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000278084.35122.4e
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CARDIOVASCULAR ANESTHESIOLOGY

Proximal Isovelocity Surface Area Should Be Routinely Measured in Evaluating Mitral Regurgitation: A Core Review

A. Stephane Lambert, MD, FRCPC

From the Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Address correspondence to A. Stephane Lambert, MD, FRCPC, H2410, 40 Ruskin St., Ottawa, Ontario, K1Y 4W7, Canada. Address e-mail to slambert{at}ottawaheart.ca.

Abstract

The proximal isovelocity surface area (PISA) measurement, also known as the "flow convergence" method, can be used in echocardiography to estimate the area of an orifice through which blood flows. It has many applications, but this review focuses only on its use in the intraoperative evaluation of mitral regurgitation. In that setting, PISA provides a quantitative assessment of the severity of mitral regurgitation and it is useful in clinical decision-making in the operating room. In this review, I discuss the physical principles behind the PISA method, along with the various mathematical formulas used to calculate the effective mitral regurgitant orifice area, the regurgitant volume, and the regurgitant fraction. A step-by-step approach is presented and illustrated with graphic and video demonstrations. Finally, I will discuss the various limitations and technical considerations of PISA measurement in the operating room.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.