Regurgitant Volume by PISA in Aortic Regurgitation

How to get Regurgitant Volume by PISA.

1. Obtain a CFD of the AR Jet with a good PISA formation under zoomed view. The DTG AVLAX, TG AVLAX, or ME AVLAX views should provide a good PISA formation. The DTG view is optimal for the CWD mode also.
2. Measure the Diameter of the PISA radius. The radius is from the center of the PISA formation, typically from the center of the valve, to the first aliasing velocity. If the PISA is small, try slightly decreasing the aliasing velocity (VA) which will increase the size of the PISA formation.
3. Obtain a VTI of the Regurgitant Jet by CWD. From the flow profile the Vmax and the VTI of the regurgitant jet can be obtained by tracing the diastolic flow profile.
4. Obtain the angle of the PISA formation. The angle is typically 180 degrees.