Parameters for evaluation of the severity of prosthetic aortic valve regurgitation

Parameter	Mild	Moderate	Severe
Valve structure and motion
Mechanical or bioprosthetic	Usually normal	Abnormal*	Abnormal*
Structural parameters
LV size	Normal^¶	Normal or mildly dilated^¶	Dilated^¶
Doppler parameters (qualitative or semiquantitative)
Jet width in central jets (percent LVO diameter): color^Δ	Narrow (≤25%)	Intermediate (26 to 64%)	Large (≥65%)
Jet density: CW Doppler	Incomplete or faint	Dense	Dense
Jet deceleration rate (PHT): CW Doppler^◊	Slow (>500 ms)	Variable (200 to 500 ms)	Steep (<200 ms)
LVO flow versus pulmonary flow: PW Doppler	Slightly increased	Intermediate	Greatly increased
Diastolic flow reversal in the descending aorta: PW Doppler	Absent or brief early diastolic	Intermediate	Prominent, holodiastolic
Doppler parameters (quantitative)
Regurgitant volume	<30 mL/beat	30 to 59 mL/beat	>60 mL/beat
Regurgitant fraction	<30%	30 to 50%	>50%

CW: continuous wave; PW: pulsed wave; LV: left ventricular; LVO: left ventricular output; PHT: pressure half-time; AVR: aortic valve regurgitation.
* 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.
Δ Parameter applicable to central jets and is less accurate in eccentric jets; Nyquist limit of 50 to 60 cm/s.
◊ Influenced by LV compliance.

Reproduced from: Zoghbi WA, Chambers JB, Dumesnil JG, et. al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound. J Am Soc Echocardiogr 2009; 22:975. Table used with the permission of Elsevier Inc. All rights reserved.

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Parameters for evaluation of the severity of prosthetic aortic valve regurgitation