| Mild | Moderate | Severe |
|---|---|---|
| Valve structure | ||
| Usually normal | Abnormal or valve dehiscence | Abnormal or valve dehiscence |
| RV size | ||
| Normal* | Normal or dilated | Dilated*** |
| Jet size by color Doppler (central jets)***** | ||
| Thin with a narrow origin; jet width ≤25% of pulmonary annulus | Intermediate; jet width 26%-50% of pulmonary annulus | Usually large, with a wide origin; jet width >50% of pulmonary annulus;may be brief in duration |
| Jet density by CW Doppler | ||
| Incomplete or faint | Dense | Dense |
| Jet deceleration rate by CW Doppler | ||
| Slow deceleration | Variable deceleration | Steep deceleration****, early termination of diastolic flow |
| Pulmonary systolic flow vs systemic flow by PW Doppler** | ||
| Slightly increased | Intermediate | Greatly increased |
| Diastolic flow reversal in the pulmonary artery | ||
| None | Present | Present |
Adapted from Zoghbi et al.
*Unless other cause of RV dilatation exists, including residual postsurgical dilatation.
**Cutoff values for regurgitant volume and fraction are not well validated.
***Unless there are other reasons for RV enlargement. Acute PR is an exception. RV volume overload is usually accompanied with typical paradoxical septal motion.
****Steep deceleration is not specific for severe PR.
*****At a Nyquist limit of 50 to 60 cm/s; parameter applies to central jets and not eccentric jets.