Pulmonic regurgitation echocardiography

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Echocardiography

M-Mode echocardiography

Right ventricular enlargement is often present with a right ventricular volume overload pattern. Fine diastolic fluttering of the tricuspid valve may be observed. Premature opening of the pulmonic valve (defined as pulmonic valve opening on or before the QRS complex) may be observed as result of severe acute pulmonary insufficiency.

2-D echocardiography

Two-dimensional echocardiography may reveal the anatomic basis for the pulmonary insufficiency including causes such as infective endocarditis and valvular pulmonic stenosis. Dilatation of the right ventricle may be present, as well as a right ventricular volume overload pattern.

PW Doppler echocardiography

Care must be exercised in interpreting pulse wave Doppler echocardiography as up to 87% of normal patients may appear to have pulmonary insufficiency on examination. It is therefore critical to calculate the length and duration of the regurgitant jet to differentiate between true and physiologic insufficiency. In physiologic insufficiency the jet is < 1 cm in length and not holodiastolic in duration. The severity of pulmonary insufficiency should be assessed using mapping techniques.

CW Doppler echocardiography

In this analysis, a comparison is made between the regurgitant Doppler spectral display and the pulmonic outflow Doppler spectral display. The pulmonary artery end-diastolic pressure is assessed as well.

Color Flow Doppler echocardiography

In this analysis, the length and width of the pulmonary insufficiency is assessed. If there is a pattern of proximal acceleration (flow convergence), this is consistent with 3+ or 4+ pulmonary insufficiency.

Assessment of severity

PW and Color flow Doppler

• Physiologic : < 1 cm in length and not holodiastolic in duration
• Borderline : 1 to 2 cm in length and holodiastolic in duration
• Clinically significant : > 2 cm in length with a peak velocity > 1. 5 m/sec and holodiastolic in duration

CW Doppler Spectral Strength of Regurgitant Jet

• Grade 1+ : Spectral tracing stains sufficiently for detection, but not enough for clear delineation
• Grade 2+ : Complete spectral tracing can just be seen
• Grade 3+ : Distinct darkening of spectral tracing is visible but density is less than antegrade flow
• Grade 4+ : Dark-stained spectral tracing