Quantitative Evaluation of Regurgitant Volume in the Patients with Mitral Regurgitation Using Color Doppler Proximal Isovelocity Surface Area Method

ABSTRACT

BACKGROUND: The Evaluation of valvular regurgitation is a long standing clinical problem. While many ways to evaluate the severity of valvular insufficiency have been tried, none allows precise quantification of regurgitation volume. Invasive angiographic grading of mitral regurgitation is semiquantitative and subjective. Recent studies have shown that using color Doppler flow mapping can identify a blue-red aliasing radius, corresponding to a proximal isovelocity surface area(PISA), proximal to a regurgitant orifice. Thus regurgitant volume across the mitral orifice can be calculated. METHODS: The clinical applicability of the PISA method was evaluated prospectively in 23 patients with mitral regurgitation and also the regurgitant volume calculated by using the time-velocity integral(TVI) method. The regurgitant jet area were compared to regurgitant volume calculated from the PISA method. RESULTS: 1) Regurgitant volume calculated by using the PISA method correlated well with the regurgitant volume calculated by using the TVI method(r=0.73, P=0.0001). 2) Regurgitant volume calculated by using the PISA method did not correlate with the regurgitant jet to left atrial ratio(r=-0.02, P=0.94). 3) Eccentricity of regurgitant flow did not influence the result of PISA method. CONCLUSIONS: It is concluded that PISA method by color Doppler flow imaging is simple and useful noninvasive method for the quantitative evaluation of mitral regurgitant volume.