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J Vet Sci. 5(2): 163~171

Quantification of mitral regurgitation using proximal isovelocity surface area method in dogs
Hojung Choi, Kichang Lee, Heechun Lee, Youngwon Lee, Dongwoo Chang, Kidong Eom, Hwayoung Youn, Mincheol Choi, Junghee Yoon
Department of Radiology, College of Veterinary Medicine, Seoul National University, Seoul 151-742, Korea. heeyoon@snu.ac.kr 1Department of Radiology, College of Veterinary Medicine, Gyeongsang National University, Jinju 660-701, Korea. 2Department of Radiology, College of Veterinary Medicine, Chungnam National University, Daejeon 305-764, Korea. 3Department of Radiology, College of Veterinary Medicine, Chungbuk National University, Cheongju 361-763, Korea. 4Department of Radiology, College of Veterinary Medicine, Kyungpook National University, Daegu 702-701, Korea.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The present study was performed to determine the accuracy and reproducibility of calculating the mitral regurgitant orifice area with the proximal isovelocity surface area (PISA) method in dogs with experimental mitral regurgitation and in canine patients with chronic mitral insufficiency and to evaluate the effect of general anesthesia on mitral regurgitation. Eight adult, Beagle dogs for experimental mitral regurgitation and 11 small breed dogs with spontaneous mitral regurgitation were used. In 8 Beagle dogs, mild mitral regurgitation was created by disrupting mitral chordae or leaflets. Effective regurgitant orifice (ERO) area was measured by the PISA method and compared with the measurements simultaneously obtained by quantitative Doppler echocardiography 4 weeks after creation of mitral regurgitation. The same procedure was performed in 11 patients with isolated mitral regurgitation and in 8 Beagle dogs under two different protocols of general anesthesia. ERO and regurgitant stroke volume (RSV) by the PISA method correlated well with values by the quantitative Doppler technique with a small error in experimental dogs (r = 0.914 and r = 0.839) and 11 patients (r = 0.990 and r = 0.996). The isoflurane anesthetic echocardiography demonstrated a significant decrease of RSV, and there was no significant change in fractional shortening (FS), ERO area, LV end-diastolic and LV end-systolic volume. ERO area showed increasing tendency after ketamine-xylazine administration, but not statistically significant. RSV, LV end-systolic and LV end-diastolic volume increased significantly (p < 0.01), whereas FS significantly decreased (p < 0.01). The PISA method is accurate and reproducible in experimental mitral regurgitation model and in a clinical setting. ERO area is considered and preferred as a hemodynamic-nondependent factor than other traditional measurements.