Tricuspid Valve Area by PISA

How to get a Tricuspid Valve Area by PISA Formation

1. Obtain a Zoomed CFD of the TV in the GE or ME Bicaval view. If there is a sufficiently stenosed tricuspid valve, a PISA formation will occur. The distance from the center of the PISA formation to it's first aliasing velocity edge (where the color shifts from blue to red) is the radius of the PISA formation.
2. Note the aliasing velocity. The aliasing velocity is the velocity where if the flow exceeds this velocity the flow will be displayed with colors from the opposite scale.
3. Obtain a continuous wave doppler (CWD) of the tricuspid valve. The CWD of the mitral valve will yield a flow profile where, utilizing the calipers (or you can trace it) to show the peak velocity.
4. Obtain an angle of the PISA formation: The angle at the tricuspid valve is typically 120 degrees, whereas the angle for the aortic valve (for aortic stenosis calculations) is typically 180 degrees.