Table 26. Stages of Severe PR
Stage Definition
Valve
Anatomy
Valve
Hemodynamics
Hemodynamic
Consequences Symptoms
C, D Severe PR Distorted
or absent
leaflets,
annular
dilation
• Color jet fills
RVOT
• CW jet
density and
contour:
dense
laminar flow
with steep
deceleration
slope; may
terminate
abruptly
• Paradoxical
septal motion
(volume
overload
pattern)
• RV enlargement
None or
variable and
dependent
on cause of
PR and RV
function
Table 27. Stages of Severe PS
Stage Definition Valve Anatomy
Valve
Hemodynamics
Hemodynamic
Consequences Symptoms
C, D Severe PS • Thickened,
distorted,
possibly
calcified
leaflets with
systolic
doming and/
or reduced
excursion
• Other
anatomic
abnormalities
may be
present, such
as narrowed
RVOT
V
max
>4 m/s;
peak
instantaneous
gradient
>64 mm Hg
• RVH
• Possible
RV, RA
enlargement
• Poststenotic
enlargement
of main PA
None or
variable and
dependent
on
severity of
obstruction
35
Pulmonic Valve Disease
