Echocardiographic parameters for grading the severity of pulmonic regurgitation

Parameter	Mild	Moderate	Severe
Pulmonic valve	Normal	Normal or abnormal	Abnormal
Right ventricular size	Normal^*	Normal or dilated	Dilated^¶
Regurgitant jet width by color Doppler^Δ	Thin (usually <10 mm in length) with a narrow origin	Intermediate (<50% of pulmonic valve annulus)	Usually large (>50% of pulmonic valve annulus), with a wide origin; may be brief in duration
Jet density and deceleration rate by CW^◊	Soft; slow deceleration	Dense; variable deceleration	Dense; steep deceleration with early termination of diastolic flow
Pulmonic/systemic stroke volume ratio by PW^§	Slightly increased	Intermediate	Significantly increased

CW: continuous wave Doppler; PW: pulsed wave Doppler.

* Unless there are other reasons for RV enlargement. Normal 2D measurements from the apical four-chamber view; RV basal diameter ≤4.1 cm, RV end-diastolic area indexed to BSA is ≤12.6 cm²/m² in men and ≤11.5 cm²/m² in women^[1].

¶ Exception: acute pulmonic regurgitation.

Δ At a Nyquist limit of 50 to 60 cm/s.

◊ Steep deceleration is not specific for severe PR.

§ Cut-off values for regurgitant volume and fraction are not well validated.

Original figure modified for this publication. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16:777. Table used with the permission of Elsevier Inc. All rights reserved.

Updated with data from:

Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1.

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Echocardiographic parameters for grading the severity of pulmonic regurgitation