Canonical: https://echosuite.app/guides/mitral-pisa/

# Mitral stenosis · PISA valve area calculator

Explore mitral stenosis · pisa valve area with the method’s inputs, acquisition guidance and source references. Open the calculator to enter measurements or try an illustrative worked example.

Created by [Mohammed Kamareddine, MD](https://echosuite.app/about/) · [Sources & educational scope](https://echosuite.app/about/)

[Open interactive calculator →](https://echosuite.app/calculators/#mitral-pisa)

## Method

MVA = (2πr²Vₐ ÷ Vmax) × θ/180

Use the measurement units shown below. Some fields apply only to a selected method or condition; follow the interactive tool’s method choices. The interactive tool keeps missing measurements incomplete and provides its method-specific results and reference context.

## Measurements and acquisition

### PISA radius  cm

Color Doppler · peak-flow frame

- Zoom on the valve and center the flow-convergence region.
- Shift the color baseline until the shell is as hemispheric as possible.
- Measure from the regurgitant orifice to the first aliasing boundary along the jet centerline.

### Aliasing velocity  cm/s

Shifted color scale · absolute cm/s

- Use the same color-Doppler frame used for the radius.
- Read the Nyquist limit after baseline shift, not the jet velocity.
- Enter the absolute displayed value in cm/s.

### Peak mitral velocity  m/s

Continuous-wave Doppler

- Align the CW cursor as parallel as possible to the jet.
- Acquire a dense, complete envelope without truncation.
- Measure the highest absolute velocity on the selected envelope.

### Funnel angle θ  degrees

Enter the measured value in the displayed unit

- Confirm the variable matches the selected formula.
- Use the unit displayed beside the field.
- Keep measurements from the same representative hemodynamic state.

## Sources and method context

American Society of Echocardiography · 2023 · Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease · PISA method and angle correction pp. 6–7 · Table 1 p. 6 · alternative-method recommendation p. 7

[Primary reference](https://www.asecho.org/wp-content/uploads/2025/04/PIIS0894731722005211.pdf)

- Equation & angle correction · PISA method · PDF pp. 6–7

Flow-convergence method, transmitral peak velocity, and angle correction for the nonhemispheric convergence of the funnel-shaped rheumatic valve.

- Method limitations · PISA method · PDF p. 7

Technical complexity, multiple measurements, geometric assumptions, and lack of recommendation for routine use.

- Severity & clinical role · Table 1 p. 6 · alternative-method recommendation p. 7

Current MVA grades and use only as a corroborating method when planimetry, PHT, and mean gradient are inconclusive.

Catalogue review status: Exact guideline locator mapped · clinical sign-off pending

These pages describe the educational tool. Interpret measurements with the complete clinical context and the method’s acquisition limitations.

## Keep exploring

- [Aortic valve area calculator: continuity equation and stress echo](https://echosuite.app/guides/aortic-stenosis/)
- [Mitral valve area calculator: pressure half-time](https://echosuite.app/guides/mitral-pht/)
- [Mitral valve area calculator: continuity equation](https://echosuite.app/guides/mitral-continuity/)
- [Tricuspid stenosis · significance calculator](https://echosuite.app/guides/tricuspid-stenosis/)

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