35
Valve Hemodynamics
a
Hemodynamic
Consequences Symptoms
No or trace TR None None or in
relation to
other le heart
or pulmonary/
pulmonary
vascular disease
Mild TR:
• Central jet area <5.0 cm
2
• Vena contracta width not defined
• Continuous wave (CW) jet density
and contour: soft and parabolic
• Hepatic vein flow: systolic dominance
Moderate TR:
• Central jet area 5–10 cm
2
• Vena contracta width not defined
but <0.70 cm
• CW jet density and contour: dense,
variable contour
• Hepatic vein flow: systolic blunting
Mild TR:
• RV/RA/IVC size normal
Moderate TR:
• No RV enlargement
• No or mild right atrium
(RA) enlargement
• No or mild IVC
enlargement with normal
respirophasic variation
• Normal RA pressure
None or in
relation to
other le heart
or pulmonary/
pulmonary
vascular disease
• Central jet area >10.0 cm
2
• Vena contracta width >0.7 cm
• CW jet density and contour:
dense, triangular with early peak
• Hepatic vein flow: systolic reversal
• RV/RA/IVC dilated
with decreased IVC
respirophasic variation
• Elevated RA pressure
with "c-V" wave
• Diastolic interventricular
septal flattening may be
present
None, or in
relation to
other le heart
or pulmonary/
pulmonary
vascular disease
• Central jet area >10.0 cm
2
• Vena contracta width >0.70 cm
• CW jet density and contour:
dense, triangular with early peak
• Hepatic vein flow: systolic reversal
• RV/RA/IVC dilated
with decreased IVC
respirophasic variation
• Elevated RA pressure
with "c-V" wave
• Diastolic interventricular
septal flattening
• Reduced RV systolic
function in late phase
Fatigue,
palpitations,
dyspnea,
abdominal
bloating,
anorexia,
edema
a
Several valve hemodynamic criteria are provided for assessment of severity of TR, but not all
criteria for each category will necessarily be present in every patient. Categorization of severity of
TR as mild, moderate, or severe also depends on image quality and integration of these parameters
with clinical findings.
