#1: What is the cause of the flow convergence (PISA formation)?
Explanation: The flow convergence or PISA formation in the LV/LVOT that is sometimes present is due to the flow acceleration of blood out of the ventricle. Since the CFD maximum velocity is 50 cm/sec, any flow that exceeds that velocity will alias, thereby producing a pseudo-flow convergence. If the LVOT is more perpendicular to the scan line than what is present in this video, the flow may also produce a fake flow convergence or PISA formation. A VSD in the septum with a flow convergence or PISA formation can also be a cause, however, one would expect to see a jet in the RV and, possibly, a defect in the septum.
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