Echo evaluation of PR

Echocardiographic Evaluation of Pulmonary Regurgitation (PR)

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1. 2D Echocardiography (Structural Assessment)

Assess pulmonary valve morphology (normal, dysplastic, post-surgical, infective)

Evaluate right ventricle (RV):

RV dilatation (chronic PR hallmark)

RV systolic function

Look for:

Dilated main pulmonary artery

Associated congenital lesions (e.g., repaired TOF)

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2. Color Doppler Assessment

Visualize diastolic regurgitant jet from pulmonary artery → RVOT

Assess:

Jet width

Jet length

Vena contracta width

Severe PR:

Broad jet filling RVOT

Mild PR:

Thin, short jet near valve

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3. Continuous Wave (CW) Doppler

Key parameters:

Density of signal → dense = severe

Deceleration slope → steep slope = severe PR

Early termination of flow

Pressure Half-Time (PHT)

Short PHT → more severe PR

Typical interpretation:

PHT < 100 ms → Severe PR

100–200 ms → Moderate

> 200 ms → Mild

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4. Pulsed Wave (PW) Doppler

Sample in main pulmonary artery / branch PAs

Findings:

Diastolic flow reversal

Holodiastolic reversal → severe PR

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5. Indirect Signs of Severe PR

Marked RV dilatation

Paradoxical septal motion

Dilated pulmonary artery

Reduced RV function (late)

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6. Quantitative & Supportive Parameters

Vena contracta width

Regurgitant fraction (advanced echo/CMR)

3D echo / CMR (gold standard for RV volumes in chronic PR)

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7. Common Causes of PR

Post repair of Tetralogy of Fallot (most common)

Pulmonary hypertension (functional PR)

Infective endocarditis

Carcinoid syndrome

Congenital pulmonary valve abnormalities

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8. Severity Grading (Integrated Approach)

Parameter Mild Moderate Severe

Color jet Small, narrow Intermediate Wide, fills RVOT

CW Doppler Faint Moderate Dense, steep slope

PHT >200 ms 100–200 ms <100 ms

PW Doppler No reversal Brief reversal Holodiastolic reversal

RV size Normal Mild dilatation Marked dilatation

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Key Takeaway

No single parameter is sufficient → always use an integrated multiparametric approach

Chronic severe PR → RV volume overload → RV dilatation → dysfunction

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