EchocardiographyExercise StressMiscEchocardiography
Aortic Valve Velocity RatioLV EF (Modified Quinones Equation)Myocardial Performance Index (RV)
AVA (Continuity Equation VTI)LV EF (Simplified Quinones Equation)PCWP by E/Ea (Nagueh Formula)
AVA (Continuity Equation VMax)LV Fractional ShorteningPISA (Mitral regurgitation)
dP/dt (LV contractility)LV Mass and LV Mass IndexPISA (Mitral stenosis)
dP/dt (RV contractility)Mitral valve area (PHT)Qp/Qs
Left atrial pressure (MR)Mitral Valvuloplasty Score (MGH)RVSP (TR)
LA Volume (Biplane Method)Modified Bernoulli EquationStroke Volume, Cardiac Output
LV EF (Dumesnil Method)Myocardial Performance Index (LV)
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PISA Method in Quantitating Mitral Stenosis

Calculation


r cm
Vr cm/s
VMax m/s
α deg0


VFR cc
MVA cm2
Calculate

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Information

Definition of Mitral Stenosis Severity

MVA (cm2)
Normal 4.0-5.0
Mild >1.5
Moderate 1.0-1.5
Severe <1.0

PISA (Mitral Stenosis)

Estimation of the mitral valve area using the principle of conservation of mass by analyzing the Proximal Isovelocity hemispheric Surface Area (PISA) of the flow convergence on the atrial side. Due to funnel shape of the proximal convergence, it is important to take into account the angle correction, α when the aliasing velocity (Vr <40 cm/s). If the aliasing velocity is high (Vr >40 cm/s), it is not as important since the PISA approximates a hemisphere.

MVA =
2πr2 *
Vr
VMax
*
α0
1800

Variable Definition
Input
2 × π × r2 Proximal isovelocity hemispheric surface area at a radial distance r from the orifice
Vr Aliasing velocity at the radial distance r (cm/s)
VMax Peak mitral stenosis velocity by CW (m/s)
α Angle between two mitral leaflets on the atrial side (degree0)
Output
VFR Volume Flow Rate (cc)
MVA Mitral valve area (cm2)

References

Baumgartner H, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009 Jan;22(1):14, 17.
Rodriguez L., et al. Validation of the proximal flow convergence method. calculation of orifice area in patients with mitral stenosis. Circulation. 1993 Sep; 88(3):1157-65.
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Author: Dr. Chi-Ming Chow Developer: Edward Brawer Illustrator: Ellen Ho
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