Ziani Abdelkader Boutaleb, Latcu Decebal Gabriel, Abadir Sylvia, Paranon Soizic, Dulac Yves, Guerrero Felipe, Acar Philippe
Cardiologie pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31000 Toulouse, France.
Arch Cardiovasc Dis. 2009 Mar;102(3):185-91. doi: 10.1016/j.acvd.2008.12.008. Epub 2009 Mar 6.
The proximal isovelocity surface area (PISA) method is validated to quantify mitral regurgitation (MR) and ventricular shunt (VS). However, the two-dimensional echocardiography (2DE) PISA method assumes a hemispherical distribution of velocity factors proximal to the MR or VS orifice.
To assess the PISA shape by three-dimensional echocardiography (3DE) in a paediatric population with MR or VS. According to the true PISA shape, we suggest different models to calculate the MR or VS volume by the 3DE PISA method.
Thirty-one paediatric patients (aged 1month to 20years, median 69months) were included: 17 had MR and 14 had VS. The orifice area and volume of MR and VS were evaluated by 2DE. 3DE acquired the entire PISA volume at orifice level. The PISA shape was estimated according to three diameters as being hemispherical, prolate hemispheroid, oblate hemispheroid and hemiellipsoid.
Data from 28patients were analysed. The PISA shape was variable: hemispherical, 11%; prolate hemispheroid, 43%; oblate hemispheroid, 32%; hemiellipsoid, 14%. Oblate hemispheroids occurred more frequently in the MR group (47%), whereas prolate hemispheroids occurred more frequently in the VS group (62%); hemispheres were scarce in both groups (10%). The mean MR or VS orifices and volumes measured by 2DE and 3DE were significantly different (0.123cm(2) versus 0.094cm(2) and 13.2mL versus 10.1mL, respectively; p=0.019).
3DE describes the true surface of the PISA shape. In a paediatric population with MR or VS, the PISA is rarely hemispherical but is more often prolate or oblate hemispheroid.
近端等速表面积（PISA）法已被证实可用于量化二尖瓣反流（MR）和心室分流（VS）。然而，二维超声心动图（2DE）的PISA法假定在MR或VS瓣口近端的速度因子呈半球形分布。
通过三维超声心动图（3DE）评估患有MR或VS的儿科人群的PISA形状。根据真实的PISA形状，我们建议采用不同的模型通过3DE PISA法计算MR或VS容积。
纳入31例儿科患者（年龄1个月至20岁，中位数69个月）：17例患有MR，14例患有VS。通过2DE评估MR和VS的瓣口面积和容积。3DE在瓣口水平获取整个PISA容积。根据三个直径将PISA形状估计为半球形、长椭球体、扁椭球体和半椭球体。
分析了28例患者的数据。PISA形状各异：半球形占11%；长椭球体占43%；扁椭球体占32%；半椭球体占14%。扁椭球体在MR组中出现的频率更高（47%），而长椭球体在VS组中出现的频率更高（62%）；两组中半球形均较少见（10%）。2DE和3DE测量的平均MR或VS瓣口及容积有显著差异（分别为0.123cm²对0.094cm²和13.2mL对10.1mL；p = 0.019）。
3DE描绘了PISA形状的真实表面。在患有MR或VS的儿科人群中，PISA很少为半球形，而更常见的是长椭球体或扁椭球体。
