1. Orlando Deffer, MD PISA

2. PISA and its hydrodynamic principle. PISA and its hydrodynamic principle. Calculation – EROA= 6.28rsqxVa/PKreg Calculation – EROA= 6.28rsqxVa/PKreg Measurement of PISA by color flow mapping requires adjustment of the aliasing velocity such that a well hemisphere is shown. Measurement of PISA by color flow mapping requires adjustment of the aliasing velocity such that a well hemisphere is shown.

3. Limitations- Limitations- More accurate for central jets and for regurgitation with a circular orifice More accurate for central jets and for regurgitation with a circular orifice Difficulty in judging the precise location of the orifice and the flow convergance shape. Difficulty in judging the precise location of the orifice and the flow convergance shape. Recent modifications of the described PISA method use the distance between two aliasing contours Recent modifications of the described PISA method use the distance between two aliasing contours

13. PISA PISA Much less experience exists for assessment of AR compared to MR Much less experience exists for assessment of AR compared to MR ECHO is performed from the apical, para- apical views, or the upper right-sternal border, with images zoomed on the valvular and supravalvular region. Due to interposition of valve tissue it’s less feasible than MR

14. Pitfalls- Pitfalls- Difficult in obtaining high quality images of the flow convergance region. Difficult in obtaining high quality images of the flow convergance region. Timing of measurement of the flow convergance radius, which should be in early diastole, closest to the peak regurgitant velocity. Ascending aortic aneurysms, which deform the valvular plane, may lead to underestimation of AR by this method. Thresholds for severe AR are an EROA>0.3cmsq or RV>60ml.