Premium
Proximal Isovelocity Surface Area (PISA) as a Noninvasive Method for the Estimation of the Shunt Quantification in Perimembranous Ventricular Septal Defects
Author(s) -
Eren Mehmet,
Dagdeviren Bahadir,
Bolca Osman,
Polat Mustafa,
Gürlertop Yekta,
Norgaz Tugrul,
Tezel Tuna
Publication year - 2001
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1046/j.1540-8175.2001.00137.x
Subject(s) - shunt (medical) , body surface area , nuclear medicine , medicine , doppler effect , cardiac catheterization , cardiology , physics , astronomy
This study was designed to assess the reliability of the proximal isovelocity surface area (PISA) method for the estimation of shunt quantification in perimembranous ventricular septal defects (PVSD). The study group was composed of 30 patients ( age 11 ± 7 years, 13 female ) with PVSD. The shunt flow (Qp‐Qs) and the ratio of the pulmonary flow to the systemic flow (Qp/Qs) were calculated by spectral Doppler and catheterization. The Qp‐Qs, the defect area (DA), and the shunt volume (SV) were obtained by the PISA method. The PISA method estimated the DA ( cm 2 /m 2 ), the SV ( cm 3 /m 2 ), and the Qp‐Qs ( L/min/m 2 ) to be equal to ( 2 ×π× R 2 × NL)/(V max × Body surface area ), DA × TVI shunt , and to SV × Heart rate , respectively (R is the distance of the maximal PISA from the first aliasing line to the left ventricular side of the defect, NL is the nyquist limit, and V max and TVI shunt are the peak velocity and time‐velocity integral of transdefect Doppler tracing obtained by continuous‐wave Doppler). The PISA method ( 3.4 ± 1.5 L/min/m 2 ) underestimated the Qp‐Qs according to spectral Doppler ( r = 0.96, P < 0.001; mean difference −0.74 ± 0.61 L/min/m 2 ; SEE = 0.11 L/min/m 2 , P < 0.001 ) and catheterization ( r = 0.92, P < 0.001; mean difference − 0.45 ± 0.7 L/min/m 2 ; SEE = 0.13 L/min/m 2 , P < 0.001 ). The correlations between the PISA findings (Qp‐Qs, DA, SV) and the catheterization Qp/Qs (r − 0.86, 0.84, and 0.86; P < 0.001, respectively), or between these and the spectral Doppler Qp/Qs ( r = 0.80, 0.80, and 0.79; P < 0.001, respectively ) were significant. The accuracies of the PISA findings in identifying large defects were high ( 0.90, 0.93, and 0.90 for cut‐off values of Qp‐Qs = 3.67 L/min/m 2 , DA = 0.44 cm 2 /m 2 , and SV = 43 cm 3 /m 2 , respectively ). As a result, the PISA method can be a simple and reliable alternative to the spectral Doppler method in the identification of large shunts in PVSD.