None | No pulmonary regurgitation on Doppler study |
---|---|
Grade I | Pulmonary regurgitation jet width ⩽ 10% of pulmonary valve annulus diameter in precordial short axis view |
No right ventricle volume overload | |
Grade II | Pulmonary regurgitation jet width 11–25% of pulmonary valve annulus diameter |
No right ventricle volume overload | |
Grade III | Pulmonary regurgitation jet width 26–50% of pulmonary valve annulus diameter |
No right ventricle volume overload but with or without flat septal motion | |
Grade IV | Pulmonary regurgitation jet width > 50% of pulmonary valve annulus diameter |
Right ventricle volume overload present |
Jet width at the origin of regurgitation jet rather than jet length was used for grading because the jet width is not influenced by pulmonary artery pressures.
Right ventricle volume overload is defined as enlarged right ventricle (> 95 percentile) and flat to paradoxical septal motion.