PISA Mitral Regurgitation Calculator

Determines the regurgitant volume, effective regurgitant orifice and volume flow rate based on Doppler measurements.

Refer to the text below the tool for more information about the formulas used and their result interpretation.


The Proximal Isovelocity Surface Area (PISA) of a Doppler regurgitant color flow jet is based on the hemodynamic principle of flow convergence and can be used to estimate the degree of valvular insufficiency.

Mitral valve regurgitation is a condition in which the mitral valve does not close tightly as it should and allows blood to flow backward.


  • Volume Flow Rate VFR (mL/s) = 2 x π x r2 x Vr
  • Effective Regurgitant Orifice ERO (mm2) = VFR / Vmax
  • Regurgitant Volume RVol (mL/beat) = ERO x VTI
Interpretation ERO (mm2) RVol (mL/beat)
Mild <20 <30
Mild-Moderate 20-30 30-45
Moderate-Severe 30-40 45-60
Severe ≥40 ≥60

Radial distance from orifice (r)
Aliasing velocity at the radial distance (Vr)
Peak velocity of the mitral regurgitant jet (Vmax)
VTI of the mitral regurgitant jet
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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

Mitral Regurgitation by PISA method

The Proximal Isovelocity Surface Area (PISA) of a Doppler regurgitant color flow jet is based on the hemodynamic principle of flow convergence and can be used to estimate the degree of valvular insufficiency.

Mitral valve regurgitation is a condition in which the mitral valve does not close tightly as it should and allows blood to flow backward. Some of the causes include mitral valve prolapse, rheumatic fever, endocarditis, sequelae from heart attack, cardiomyopathy or congenital heart defects.

The PISA method assumes that flow convergence (in a hemispherical shape) occurs around the spot where the mitral valve regurgitates (if there is a single central jet of MR).

The continuity equation can be used to calculate the area of the effective regurgitant orifice area (ERO) based on the volume flow rate and the peak mitral regurgitant velocity:

  • Volume Flow Rate VFR (mL/s) = 2 x π x r2 x Vr
  • Effective Regurgitant Orifice ERO (mm2) = VFR / Vmax

The mitral regurgitant volume is then determined by multiplying the ERO by the VTI of the mitral regurgitant jet:

  • Regurgitant Volume RVol (mL/beat) = ERO x VTI
Interpretation ERO (mm2) RVol (mL/beat)
Mild <20 <30
Mild-Moderate 20-30 30-45
Moderate-Severe 30-40 45-60
Severe ≥40 ≥60

Some of the limitations of the PISA method include:

  • Both the CW Doppler and PISA radius must be taken at same point in cardiac cycle, which may prove quite difficult;
  • If the jet is not holosystolic there is risk of overestimation so RVol is more appropriate;
  • The method only depends on a single-frame image.
 

References

Enriquez-Sarano M, Seward JB, Bailey KR, Tajik AJ. Effective regurgitant orifice area: a noninvasive Doppler development of an old hemodynamic concept. J Am Coll Cardiol. 1994; 23(2):443-451.

Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30(4):303-371.

Moraldo M, Cecaro F, Shun-Shin M, Pabari PA, Davies JE, Xu XY, Hughes AD, Manisty C, Francis DP. Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study. Int J Cardiol. 2013; 168(2):1220-8.

Utsunomiya T, Ogawa T, Doshi R, et al. Doppler color flow "proximal isovelocity surface area" method for estimating volume flow rate: effects of orifice shape and machine factors [published correction appears in J Am Coll Cardiol 1993 May;21(6):1537]. J Am Coll Cardiol. 1991; 17(5):1103-1111.


Specialty: Cardiology

System: Cardiovascular

Article By: Denise Nedea

Published On: July 16, 2020

Last Checked: July 16, 2020

Next Review: July 16, 2025