Assessment of proximal isovelocity surface area (PISA) shape using three-dimensional echocardiography in a paediatric population with mitral regurgitation or ventricular shunt

Ziani, Abdelkader; Laţcu, Decebal Gabriel; Abadir, Sylvia; Paranon, Soizic; Dulac, Yves; Guerrero, Felipe; Acar, Philippe

doi:10.1016/j.acvd.2008.12.008

Cited by 26 publications

(12 citation statements)

References 12 publications

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“…In one study involving 11 academic centres, the rate of "substantial agreement" among echocardiologists for distinction of severe from non-severe MR using EROA was only 38% 22). Other limitations of the two-dimensional color Doppler PISA technique, including geometric assumptions of the flow convergence zone, have become apparent from three-dimensional echocardiographic and cardiac magnetic resonance studies 30)31). The validity of using the standard PISA technique to quantitate predominantly mid-to-late systolic regurgitation characteristic of MVP is also in doubt.…”

Section: Role Of Rest Echocardiographymentioning

confidence: 99%

Surgical Timing of Degenerative Mitral Regurgitation: What to Consider

Dolor-Torres¹,

Ling

2012

J Cardiovasc Ultrasound

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Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.

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Section: Role Of Rest Echocardiographymentioning

confidence: 99%

Surgical Timing of Degenerative Mitral Regurgitation: What to Consider

Dolor-Torres¹,

Ling

2012

J Cardiovasc Ultrasound

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“…Several reports presented data on only a limited number of healthy control subjects, and some described findings in children from infants to teenagers with total sample sizes less than 50 subjects. 28,29,31 This makes it impossible to create size or age specific normal ranges. Because of the absence of a standardised methodology based on expert consensus to measure valvular gradients and severity of regurgitation in the paediatric population, all studies used different approaches.…”

Section: Methodological Limitationsmentioning

confidence: 99%

“…Systems to classify mitral stenosis severity have been rarely reported, and when employed 10,12 different cut-off values have been used to define mild, moderate, and severe stenosis. For regurgitant lesions, variable echocardiographic views (four-chamber and/or parasternal views) [29][30][31] and parameters to evaluate disease severity (i.e. proximal isovelocity surface area or vena contracta) have been used.…”

Section: Methodological Limitationsmentioning

confidence: 99%

“…Marfan syndrome), rheumatic disease (especially in developing countries), and various CHDs (before and after correction/palliation). 6,[23][24][25][26][27][28][29][30][31][32][33] Mitral regurgitation may be found in association with stenosis in all complex congenital mitral defects, as detailed in Tables 1 and 2. Rare anatomical defects of mitral valve apparatus that may cause mitral regurgitation include isolated cleft of the mitral valve, 9,34,44,45 mitral arcade or hammock valve, 8,9,32,44,45 and Ebstein's like anomaly (Tables 1 and 2).…”

Section: Mitral Valve Regurgitationmentioning

confidence: 99%

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Echocardiographic examination of mitral valve abnormalities in the paediatric population: current practices

et al. 2020

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We reviewed the recent literature for echocardiographic assessment of mitral valve abnormalities in children. A literature search was performed within the National Library of Medicine using the keywords “mitral regurgitation and/or stenosis, children.” The search was refined by adding the keywords “echocardiographic definition, classification, and evaluation.” Thirty-one studies were finally included. Significant advances in echocardiographic imaging of mitral valve defects, mainly due to the implementation of three-dimensional technology, contribute to a better understanding of the underlying anatomy. However, heterogeneity between classification systems of mitral valve disease severity is a serious problem. For regurgitant lesions, there is only very limited evidence from small studies that support the adoption of quantitative/semi-quantitative indexes commonly employed in adults. Despite the lack of evidence base, qualitative evaluation of regurgitation severity is often employed. For stenotic lesions, no clear categorisation based on trans-valvular echocardiography-derived “gradients” has been consistently applied to define mild, moderate, or severe obstruction across different paediatric age ranges. Quantitative parameters such as valve area have also been poorly validated in children. Adult recommendations are frequently applied without validation for the paediatric age. In conclusion, significant advances in the anatomical evaluation of mitral valve diseases have been made, thanks to three-dimensional echocardiography; however, limitations remain in the quantitative/semi-quantitative estimation of disease severity, both with respect to valvular regurgitation and stenosis. Because adult echocardiographic recommendations should not be simply translated to the paediatric age, more specific paediatric guidelines and standards for the assessment of mitral valve diseases are needed.

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“…8 However, it was recently shown that the true PISA is generally more hemi-elliptical than hemispherical, and that an erroneous assumption of spherical PISA underestimates the severity of MR (see Figure 1). 9 This is even more significant in those cases of functional MR. 9,10 Despite attempts to introduce corrections to the PISA formula, differences in orifice shape, size, and leaflet angle made strict formulae always inaccurate in the presence of non-circular lesions. 9,11,12 To minimize the effect of this limitation, cut-off values for severity grading are different in functional versus organic MR (≥0.2 cm 2 versus ≥0.4 cm 2 , respectively).…”

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confidence: 99%