{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T03:47:34Z","timestamp":1776829654545,"version":"3.51.2"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1995,11,15]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>In patients with mitral valve prolapse, spontaneous changes of the effective regurgitant orifice during systole are not well documented. Such changes can now be analyzed by use of the proximal isovelocity surface area method, but the changes raise concern about the reliability of this method for assessing overall severity of regurgitation in these patients.<\/jats:p><jats:p><jats:italic>Methods and Results<\/jats:italic>In a prospective study of 42 patients with mitral valve prolapse, the effective mitral regurgitant orifice was calculated at four phases of systole (early, mid, mid-late, and late) as the ratio of regurgitant flow to regurgitant velocity by use of the proximal isovelocity surface area method. Throughout systole, the effective regurgitant orifice increased significantly, from 32\u00b127 mm<jats:sup>2<\/jats:sup>in early systole to 41\u00b127 in midsystole, 55\u00b130 in mid-late systole, and 107\u00b166 mm<jats:sup>2<\/jats:sup>during late systole (<jats:italic>P<\/jats:italic>&lt;.0001). Phasic regurgitant volume increased from early to mid-late systole but decreased in late systole. For quantitation of the overall effective regurgitant orifice, four approaches using the proximal isovelocity surface area were compared with simultaneously performed quantitative Doppler echocardiography (54\u00b130 mm<jats:sup>2<\/jats:sup>) and quantitative two-dimensional echocardiography (51\u00b129 mm<jats:sup>2<\/jats:sup>). All correlations were good (<jats:italic>r<\/jats:italic>&gt;.95), but overestimation was considerable when the largest flow convergence was used (70\u00b139 mm<jats:sup>2<\/jats:sup>; both<jats:italic>P<\/jats:italic>&lt;.0001), significant when the simple mean of the four phases was used (59\u00b136 mm<jats:sup>2<\/jats:sup>;<jats:italic>P<\/jats:italic>=.005 and<jats:italic>P<\/jats:italic>=.0007, respectively), mild when a weighted mean of the four phases was used (55\u00b133 mm<jats:sup>2<\/jats:sup>;<jats:italic>P<\/jats:italic>=.41 and<jats:italic>P<\/jats:italic>=.01, respectively), and no overestimation was observed when the effective regurgitant orifice calculated at maximum regurgitant velocity was used (54\u00b130 mm<jats:sup>2<\/jats:sup>;<jats:italic>P<\/jats:italic>=.29 and<jats:italic>P<\/jats:italic>=.17, respectively).<\/jats:p><jats:p><jats:italic>Conclusions<\/jats:italic>Phasic changes of mitral regurgitation are observed in patients with mitral valve prolapse. The effective regurgitant orifice increases throughout systole. Regurgitant volume also increases initially but tends to decrease in late systole. These changes can lead to overestimation of the overall degree of regurgitation, but properly timed measurements made by use of the proximal isovelocity surface area method allow an accurate estimation of the overall effective regurgitant orifice.<\/jats:p>","DOI":"10.1161\/01.cir.92.10.2951","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:34:42Z","timestamp":1339461282000},"page":"2951-2958","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":91,"title":["Changes in Effective Regurgitant Orifice Throughout Systole in Patients With Mitral Valve Prolapse"],"prefix":"10.1161","volume":"92","author":[{"given":"Maurice","family":"Enriquez-Sarano","sequence":"first","affiliation":[{"name":"From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., L.J.S., A.J.T., J.B.S.) and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence J.","family":"Sinak","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., L.J.S., A.J.T., J.B.S.) and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Jamil","family":"Tajik","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., L.J.S., A.J.T., J.B.S.) and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kent R.","family":"Bailey","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., L.J.S., A.J.T., J.B.S.) and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James B.","family":"Seward","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., L.J.S., A.J.T., J.B.S.) and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.48.4.684"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-83-3-312"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(86)90516-8"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(89)90588-7"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(89)90232-9"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.56.1.862151"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.60.1.170"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(79)90077-8"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/res.45.5.487530"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.90.1.8026013"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0146-2806(82)90016-0"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(82)90204-6"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.53.5.1260992"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(89)90260-X"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.74.4.3757182"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.44.3.312"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.47.6.1252"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.88.3.8353877"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00434-R"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.75.4.3829339"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(91)90738-U"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.84.4.1914090"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/res.70.5.1568302"},{"key":"e_1_3_2_24_2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0025-6196(25)00117-X","volume":"53","year":"1978","unstructured":"Tajik AJ, Seward JB, Hagler DJ, Mair DD, Lie JT. Two-dimensional real-time ultrasonic imaging of the heart and great vessels: technique, image orientation, structure identification, and validation. Mayo Clin Proc. 1978;53:271-303.","journal-title":"Mayo Clin Proc"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60540-0"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(86)80146-2"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90432-4"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(89)80014-8"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.74.2.3731421"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)90837-8"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(63)90375-2"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197104012841303"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(10)80274-8"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.65.4.7060250"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(88)90096-4"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.83.2.1991377"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90844-Q"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(92)90414-Q"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90061-5"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.89.6.8205704"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90678-T"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.88.4.8403315"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(14)80242-3"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(93)90025-5"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a059710"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.87.3.8443904"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(14)80542-7"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.92.10.2951","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T21:48:09Z","timestamp":1743371289000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.92.10.2951"}},"subtitle":["A Clinical Study Using the Proximal Isovelocity Surface Area Method"],"short-title":[],"issued":{"date-parts":[[1995,11,15]]},"references-count":47,"journal-issue":{"issue":"10","published-print":{"date-parts":[[1995,11,15]]}},"alternative-id":["10.1161\/01.CIR.92.10.2951"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.92.10.2951","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,11,15]]},"assertion":[{"value":"1994-09-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"1995-05-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"1995-11-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}