Pulmonic valve


The pulmonary valve is a tricuspid, semilunar valve that is similar in construction and size to the aortic valve. The valve has a right (R) -, a left (L) and an anterior cusp (A). The pulmonary valve has a slightly more left, anterior and superior position to the aortic valve.

Cross section of heart valves
Cross section of heart valves


Pulmonary regurgitation (PR) is a volume load for the RV. Important regurgitation will lead to RV dilation. Due to this volume load the RV will endure long but eventually will fail.

Quantification of pulmonary regurgitation

Grading the severity of PR
PR severity classes Mild Moderate Severe
Qualitative parameters
Valve morphology Normal Normal/Abnormal Abnormal
Colour flow PR jet width 𝛼 Small, usually <10mm in length with a narrow origin Intermediate Large, with a wide origin; may be brief in duration
Reversal flow in pulmonary artery branches Absent Absent Present
CW signal of PR jet 𝛽 Faint/Slow deceleration Dense/variable Dense/steep deceleration, early termination od diastolic flow
Pulmonic vs aortic flow by PW Normal or slightly increased Intermediate Greatly increased
Semi-quantitative parameters
VC width (mm) Not defined Not defined Not defined
Deceleration time of PR (ms) Not defined Not defined <260
Pressure half-time (ms) 𝛾 Not defined Not defined <100
Jet width/annulus ratio (%) Not defined Not defined >65
PR index 𝛿 Not defined Not defined <0,77
Quantitative parameters
EROA (mm²) Not defined Not defined Not defined
R Vol (mL) Not defined Not defined Not defined
RF (%) <20 20-40 >40
Structural parameters
RV size 𝜀 Usually normal Normal or dilated Usually dilated

CW, continuous wave; EROA, effective regurgitant orifice area; PR, pulmonic regurgitation; RV right ventricle; PW, pulsed wave; R Vol regurgitant volume; VC, vena contracta.
𝛼 At Nyquist limit of 50-60 cm/s.
𝛽 Steep deceleration is not specific for severe PR
𝛾 Pressure half time is shortened with increasing RV diastolic pressure.
𝛿 PR index ratio of PR duration by CW Doppler to total diastolic time.
𝜀 Unless for other reasons, the RV size is usually normal in patients with mild PR. In acute severe PR, the RV size is often normal. Accepted cut-off values for non-significant RV enlargement (measurements obtained from the apical 4-chamber view): Mid RV dimension ≦33mm, RV end-diastolic area ≦ 28cm², RV end-systolic area ≦16cm². RV fractional area change >32%, maximal.

Causes of pulmonary regurgitation

Physiologic Congenital Acquired
PR is found in 40-80% of people incorrectly constructed valve cusp(s) As a result of pulmonary hypertension.
  Absence or partial absense of a valve cusp By balloon dilatation of the PV in correction of pulmonary stenosis

Severe PR
Severe PR


Pulmonary stenosis is very rare.

Quantification of pulmonary stenosis

Parameter Mild Moderate Severe
PGmax (mmHg) < 36 36 - 64 > 64
Vmax (m/s) < 3 3 - 4 > 4

Causes of pulmonary stenosis

Congenital Acquired
Tetralogy van Fallot Rheumatic fever

Mild PS
Mild PS

The information above comes from Echocardiografie.nl. Last changed on: 11 September 2023.