Method
PISA / Flow Convergence — Mitral Regurgitation
⚠️ Shift color baseline toward MR jet (typically 25–40 cm/s). Standard PISA assumes 180° hemisphere — apply angle correction for eccentric jets.
Measured at the aliasing velocity interface
cm
Color Nyquist limit after baseline shift
cm/s
CW Doppler peak of MR jet
m/s
CW Doppler MR envelope tracing
cm
Flow (mL/s) = 2π × r² × Va
EROA (cm²) = Flow ÷ [Vmax (m/s) × 100]
RVol (mL) = EROA × MR VTI
EROA (cm²) = Flow ÷ [Vmax (m/s) × 100]
RVol (mL) = EROA × MR VTI
Results
PISA / Flow Convergence
Enter values and click Calculate
Method
Continuity / Volumetric — MV SV vs. LVOT SV
⚠️ Assumes no significant AR or other left-sided regurgitation. MV annulus assumed circular — potential source of error.
Apical 4-chamber, early diastole
cm
PWD at mitral annulus — trace full E+A envelope
cm
PLAX, midsystole, inner edge-to-inner edge
cm
PWD at LVOT (same level as diameter measurement)
cm
CW Doppler MR jet envelope — same as PISA method
cm
LVOT SV = π × (LVOT d/2)² × LVOT VTI
MV SV = π × (MV d/2)² × MV VTI
RVol = MV SV − LVOT SV
EROA = RVol / MR VTI
RF (%) = RVol / MV SV × 100
MV SV = π × (MV d/2)² × MV VTI
RVol = MV SV − LVOT SV
EROA = RVol / MR VTI
RF (%) = RVol / MV SV × 100
Results
Continuity / Volumetric
Enter values and click Calculate
Reference
MR Severity Cutoffs — AHA/ACC 2017 & ESC 2021
Grading integrates multiple parameters. No single value is definitive.
Mild
EROA< 0.20 cm²
RVol< 30 mL
RF< 30%
Vena contracta< 0.3 cm
Moderate
EROA0.20–0.39 cm²
RVol30–59 mL
RF30–49%
Vena contracta0.3–0.69 cm
Severe
EROA≥ 0.40 cm²
RVol≥ 60 mL
RF≥ 50%
Vena contracta≥ 0.70 cm
PISA Angle Correction (Eccentric Jets)
Corrected Flow = 2π × r² × Va × (α / 180°)
where α = opening angle of PISA surface in degrees
where α = opening angle of PISA surface in degrees
Method
PISA / Flow Convergence — Tricuspid Regurgitation
⚠️ Shift baseline toward TR jet. Recommended Va ~28 cm/s for TR. PISA hemisphere may underestimate massive TR.
Measured at aliasing velocity
cm
cm/s
CW Doppler TR jet
m/s
CW Doppler TR envelope tracing
cm
Flow (mL/s) = 2π × r² × Va
EROA (cm²) = Flow ÷ [Vmax (m/s) × 100]
RVol (mL) = EROA × TR VTI
EROA (cm²) = Flow ÷ [Vmax (m/s) × 100]
RVol (mL) = EROA × TR VTI
Results
TR PISA / Flow Convergence
Enter values and click Calculate
Method
Continuity / Volumetric — TV SV vs. RVOT SV
⚠️ Assumes no significant PR. TV annulus is elliptical — circular assumption is a source of error.
Apical 4-chamber, early diastole
cm
PWD at tricuspid annulus — full E+A envelope
cm
PSAX, at level of pulmonic valve
cm
PWD at RVOT / pulmonic valve level
cm
CW Doppler TR jet envelope — same as PISA method
cm
TV SV = π × (TV d/2)² × TV VTI
RVOT SV = π × (RVOT d/2)² × RVOT VTI
RVol = TV SV − RVOT SV
EROA = RVol / TR VTI
RF (%) = RVol / TV SV × 100
RVOT SV = π × (RVOT d/2)² × RVOT VTI
RVol = TV SV − RVOT SV
EROA = RVol / TR VTI
RF (%) = RVol / TV SV × 100
Results
TR Continuity / Volumetric
Enter values and click Calculate
Reference
TR Severity Cutoffs — Hahn/Zamorano Expanded Grading Framework
Expanded 5-tier grading (Hahn, Zamorano et al.) beyond the standard mild/moderate/severe scheme. Integrate with IVC size, hepatic vein flow, RV size and function.
Mild
EROA< 0.20 cm²
RVol< 30 mL
RF< 30%
VC width< 0.3 cm
PISA r≤ 0.5 cm
Moderate
EROA0.20–0.39 cm²
RVol30–44 mL
RF30–49%
VC width0.3–0.69 cm
PISA r0.6–0.9 cm
Severe
EROA0.40–0.59 cm²
RVol45–59 mL
RF≥ 50%
VC width≥ 0.70 cm
PISA r> 0.9 cm
Massive
EROA0.60–0.79 cm²
RVol60–74 mL
HV systolic blunting
IVC dilated
Torrential
EROA≥ 0.80 cm²
RVol≥ 75 mL
HV systolic reversal
IVC dilated, non-collapsible
RV dilation / dysfunction
RVSP Estimator (Modified Bernoulli)
RVSP = 4 × TR Vmax² + RAP | PASP ≈ RVSP (no RVOTO)
m/s