| Valve structure and motion |
|---|
| Mechanical or bioprosthetic |
| Mild: Usually normal Moderate: Abnormal** Severe: Abnormal** |
| Structural parameters |
| LV size |
| Mild: Normal*** Moderate: Normal or mildly dilated*** Severe: Dilated*** |
| Doppler parameters (qualitative or semiquantitative) |
| Jet width in central jets (% LVO diameter): color* |
| Mild: Narrow (≤25%) Moderate: Intermediate (26%-64%) Severe: Large (≥65%) |
| Jet density: CW Doppler |
| Mild: Incomplete or faint Moderate: Dense Severe: Dense |
| Jet deceleration rate (PHT, ms): CW Doppler**** |
| Mild: Slow (>500) Moderate: Variable (200-500) Severe: Steep (<200) |
| LVO flow vs pulmonary flow: PW Doppler |
| Mild: Slightly increased Moderate: Intermediate Severe: Greatly increased |
| Diastolic flow reversal in the descending aorta: PW Doppler |
| Mild: Absent or brief early diastolic Moderate: Intermediate Severe: Prominent, holodiastolic |
| Doppler parameters (quantitative) |
| Regurgitant volume (mL/beat) |
| Mild: <30 Moderate: 30-59 Severe: >60 |
| Regurgitant fraction (%) |
| Mild: <30 Moderate: 30-50 Severe: >50 |
PHT, Pressure half-time.
*Parameter applicable to central jets and is less accurate in eccentric jets; Nyquist limit of 50 to 60 cm/s.
**Abnormal mechanical valves, for example, immobile occluder (valvular regurgitation), dehiscence or rocking (paravalvular regurgitation); abnormal biologic valves, for example, leaflet thickening or prolapse (valvular), dehiscence or rocking (paravalvular regurgitation).
***Applies to chronic, late postoperative AR in the absence of other etiologies.
****Influenced by LV compliance.