Evaluation of the Proximal Isovelocity Surface Area Method and Vena Contracta Width in Mitral Regurgitation with the Transthoracic and Transesophageal Echocardiography

valuation of the Proximal Isovelocity Surface Area Method and Vena Contracta Width in Mitral Regurgitation with Transthoracic and Transesophageal Echocardiography To compare the proximal isovelocity surface area (PISA) method and vena contracta width (VCW) which are some of the color Doppler methods that we use in the evaluation of mitral regurgitation (MR) with transthoracic (TTE) and multiplane transesophageal echocardiography (TEE) and to determine the reliability of the TTE measurements that we use routinely for the evaluation of MR. Included were 52 patients with MR of which 25 rheumatic disease, 10 mitral valve prolapse, 12 prosthetic valve having paravalvular leakage and 5 chordal rupture (26 male, mean age: 44.2 ±16.6 years). The effective orifice area (EOA) calculated by the PISA method at TEE was chosen as the reference method. The MR area, the proportion of jet area to the left atrium area (MR area/LA), the EOA and MR volume calculated by the PISA method and VCW were used as Doppler echocardiographic parameters while evaluating the MR at TTE. The PISA and VCW were measured by TTE from parasternal long axis, apical two-and four-chamber views and by TEE from 0º, 30º-60º, 90º and 120º. The proximal isovelocity surface area and VCW have been displayed optimally at TTE and TEE 94% and 98% of the cases, respectively, and the 90% and 94% of the VCW cases. Significant correlations existed between the MR area (r =0.34, p <0.02), MR area / LA (r = 0.38, p<0.009), VCW parasternal (r=0.78, p<0.0001), VCW four chamber (r=0.72, p<0.0001), VCW two chamber (r= 0.68, p<0.001), PISA-MR volume (r=0.83, p<0.0001) and PISA-EOA (r=0.95, p<0.0001) with the reference method. It has been found that PISA-EOA, PISA-MR volume and parasternal long axis VCW were determinants of the reference method by multivariate stepwise regression analysis of the parameters measured at TTE. It was ascertained that the EOA (52 mm2) calculated by the PISA method at TTE was able to predict the estimate value of the EOA (50 mm2) calculated by the same method at TEE with a high sensitivity and specificity, the MR volume (45 ml) with a high sensitivity and the VCW at the parasternal long axis chamber (5.2 mm) with a high specificity. The regurgitant orifice area and the regurgitant volume calculated by TTE are reliable and simple parameters in the quantitative evaluation of MR. VCW must be measured on axial planes, this method can be used secondarily as a semi-quantitative method auxiliary to the PISA method since it has mediocre sensitivity for the determination of the orifice area quantitatively. Other semiquantitative methods, which are used rather frequently in routine practice, are not reliable especially in the evaluation of the degree of eccentric jets.