How do we measure the severity of Mitral Regurgitation (MR)? Enter the PISA method. 1/ PISA = Proximal Isovelocity Surface Area It's a hemispheric zone of blood flow seen on color Doppler as it rushes toward a leaky mitral valve. The faster the flow, the more curved (and larger) this shell becomes. 2/ By adjusting the Doppler baseline toward the MR jet, we get a clearer PISA "dome." Measure the radius (r) of this dome—from the valve to the first color change (aliasing point). 3/ Use this formula to calculate the size of the leaky opening: EROA = (2πr² × Valiasing) / Vmax(MR jet) EROA = Effective Regurgitant Orifice Area A larger EROA = more severe MR. 4/ To calculate how much blood is leaking: Regurgitant Volume = EROA × VTI(MR) (VTI = total flow over time from the MR jet) 5/ Why it matters: - Helps assess MR severity - Guides treatment decisions - Combines well with other echo findings #Echo #Cardiology #PISA #MitralRegurgitation #CardioTwitter