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Purpose: Proximal isovelocity surface area (PISA) method has been proposed as a quantitative method to assess the severity of aortic regurgitation. The aim of the study was to compare actual measurement of PISA with real time 3-dimensional (3D) color Doppler and calculation of PISA with 2-dimensional (2D) color Doppler echocardiography in quantitation of aortic regurgitation (AR).Methods: Forty patients with aortic regurgitation were enrolled prospectively. Regurgitant volume, calculated using continuity equation was used as the reference method. 2D PISA was calculated as 2πr2. Actual 3D PISA was measured from 8 equidistant radial planes of the 3D flow convergence. Regurgitant volume was calculated as PISA x aliasing velocity x time velocity integral of AR/ peak AR velocity.Results: Regurgitant volumes measured by continuity equation ranged between 6-76 ml. 3D PISA derived regurgitant volume and 2D PISA calculated regurgitant volume demonstrated similar correlation with the reference method (r= 0.68, p<0.001, and r= 0.63, p<0.001, respectively). There was no statistical difference between mean reference regurgitant volume, 3D PISA derived and 2D PISA calculated regurgitant volumes (25.0 ± 17.9 vs 26.5 ± 15.1 vs 22.8 ± 19 ml, respectively, p=0.3). Mean regurgitant volumes were similar for both central and eccentric jets with 3 methods (20.1 ± 14.7 vs 25.6 ± 16.1 vs 18.9 ± 19.8 ml, p=0.1 for central jets and 33.5 ± 19.7 vs 28.0 ± 12.7 vs 27.5 ± 16.7 ml, p=0.5 for eccentric jets).Conclusion: For the assessment of aortic regurgitation severity, direct measurement of PISA using real time 3D-color Doppler echocardiography and calculation of PISA by 2D color Doppler echocardiography demonstrated similar accuracy.