Pisa

Proximal or first isovelocity adjacent stenotic orifice v\4C

Fig. 12. Proximal isovelocity surface area (PISA) principle in mitral stenosis. Narrow sector scan of mitral stenotic jet using color flow Doppler in the apical four-chamber (A4C) view. The flow convergence zone exhibits a hemisphere of isovelocity (proximal isovelocity). The PISA principle stipulates that unobstructed flow convergence equates to concentric acceleration—the presence of concentric rings of flow acceleration that results when flow accelerates across the stenotic mitral valve. (Please see companion DVD for corresponding video.)

Fig. 12. Proximal isovelocity surface area (PISA) principle in mitral stenosis. Narrow sector scan of mitral stenotic jet using color flow Doppler in the apical four-chamber (A4C) view. The flow convergence zone exhibits a hemisphere of isovelocity (proximal isovelocity). The PISA principle stipulates that unobstructed flow convergence equates to concentric acceleration—the presence of concentric rings of flow acceleration that results when flow accelerates across the stenotic mitral valve. (Please see companion DVD for corresponding video.)

Mitral Valve Area

- i PISA Method

Step I

Mitral Valve Area

Pisa Echocardiography

2. Apply color flow Doppler

3. Shift of zero baseline upward (Nyquist limit)

4. Save color flow image cine loop

5. Freeze best frame to measure radius of PISA in left atrium -—*-*—

Mitral Stenosis

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