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
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.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.
The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.