Knowing the Limits: Pitfalls of Echocardiography in Mitral Regurgitation

Comparison of Mitral Regurgitant Volume Assessment between Proximal Flow Convergence and Volumetric Methods in Patients with Significant Primary Mitral Regurgitation: An Echocardiographic and Cardiac Magnetic Resonance Imaging Study

“…Advantages and pitfalls of the PISA method have already been discussed. 19 Some of the major concerns about the PISA method involve reproducibility issues in routine echocardiographic practice, physiological caveats, notably when required geometric assumptions for applying PISA regarding the MR orifice shape are not fulfilled, and sometimes technical difficulties in fully acquiring eccentric, multiple MR jets or precisely delimiting the radius of the converging hemisphere. 20 Notably, as elegantly shown by Papolla et al 21 using an in vitro model of quantification of MR, the PISA geometry should be considered to accurately quantify PISA-RVol, notably by measuring both PISA radius and width in case of oblong MR flow convergence.…”