| Pulmonic valve | |
|---|---|
| Mild: | Normal |
| Moderate: | Normal or abnormal |
| Severe: | Abnormal |
| RV size | |
| Mild: | Normal(1) |
| Moderate: | Normal or dilated |
| Severe: | Dilated |
| Jet size by color Doppler(3) | |
| Mild: | Thin (usually <10 mm in length) with a narrow origin |
| Moderate: | Intermediate |
| Severe: | Usually large, with a wide origin; May be brief in duration |
| Jet density and deceleration rate –CW(5) | |
| Mild: | Soft; Slow deceleration |
| Moderate: | Dense; variable deceleration |
| Severe: | Dense; steep deceleration, early termination of diastolic flow |
| Pulmonic systolic flow compared to systemic flow –PW(4) | |
| Mild: | Slightly increased |
| Moderate: | Intermediate |
| Severe: | Greatly increased |
CW, Continuous wave Doppler; PR, pulmonic regurgitation; PW, pulsed wave Doppler; RA, right atrium; RF, regurgitant fraction; RV, right ventricle.
A comprehensive approach to the evaluation of PR severity is recommended, similar to other valvular regurgitation. Since there is insufficient data on quantitation of PR to recommend a clinically validated quantitative approach, the evaluation is generally qualitative and should include the various parameters discussed above. Color Doppler is the best screening modality and accurately identifies trivial and mild pulmonary regurgitation as thin, small jets with a 'pin-point' origin. These lesions are readily differentiated from more severe degrees of PR. In addition to color Doppler, an evaluation of the pulmonic valve, RV size and function help elucidate the etiology of the regurgitation and the adaptation to the volume over- load. CW Doppler of the PR jet and TR jet, if available, should be routinely recorded to provide supportive evidence for the degree of regurgitation and estimation of pulmonary pressure. Quantitation of the vena contracta by color Doppler and regurgitant fraction with pulsed Doppler, although helpful, need further validation. Despite these limitations, clinically useful qualitative estimates of PR regurgitation are feasible in the majority of cases.