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
• 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 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.
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