EROA Mitral Regurgitation Calculator

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Primary MR arises from structural leaflet disease; secondary MR results from LV dysfunction without primary leaflet pathology. Severity thresholds differ between the two.
Radius of the proximal isovelocity surface area hemisphere measured from the regurgitant orifice to the first aliasing boundary on colour Doppler, at mid-systole.
cm
The colour Doppler aliasing velocity at the PISA radius. Set by adjusting the colour-flow baseline downward until a hemisphere of uniform colour is visible; typically 35-45 cm/s.
cm/s
Peak velocity of the mitral regurgitant jet on continuous-wave Doppler. Most commonly 4-6 m/s (400-600 cm/s) in haemodynamically significant MR.
cm/s
Velocity-time integral of the mitral regurgitant jet traced on continuous-wave Doppler. Used to calculate regurgitant volume per beat.
cm
EROASevere MR
0.407cm²

Effective Regurgitant Orifice Area - the primary measure of MR severity

Volume flow rate (VFR)203.6mL/s
Regurgitant volume57mL/beat
PISA area5.089cm²
MR severity gradeSevere (primary MR)
0.407 cm²
Mild<0.2Moderate0.2-0.3Mod-Severe0.3-0.4Severe0.4+

Severe (primary MR): EROA 0.407 cm², RVol 57.0 mL/beat.

  • EROA of 0.407 cm² and regurgitant volume of 57.0 mL/beat are the primary quantitative markers of MR severity.
  • Severe primary MR (EROA >= 0.40 cm², RVol >= 60 mL) typically requires surgical or interventional evaluation even in asymptomatic patients with preserved LV function.
  • The PISA method assumes a hemispherical flow-convergence zone. Accuracy is best for central, circular orifices; eccentric jets, multiple jets, or non-circular orifices may yield underestimates. Always integrate with clinical and other echocardiographic findings.

Next stepDiscuss findings with a cardiologist and consider referral to a valve specialist for surgical or catheter-based intervention planning.

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