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




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 classesMildModerateSevere
Qualitative parameters
Valve morphologyNormalNormal/AbnormalAbnormal
Colour flow PR jet width 𝛼Small, usually <10mm in length with a narrow originIntermediateLarge, with a wide origin; may be brief in duration
Reversal flow in pulmonary artery branchesAbsentAbsentPresent
CW signal of PR jet 𝛽Faint/Slow decelerationDense/variableDense/steep deceleration, early termination od diastolic flow
Pulmonic vs aortic flow by PWNormal or slightly increasedIntermediateGreatly increased
Semi-quantitative parameters
VC width (mm)Not definedNot definedNot defined
Deceleration time of PR (ms)Not definedNot defined<260
Pressure half-time (ms) 𝛾Not definedNot defined<100
Jet width/annulus ratio (%)Not definedNot defined>65
PR index 𝛿Not definedNot defined<0,77
Quantitative parameters
EROA (mm²)Not definedNot definedNot defined
R Vol (mL)Not definedNot definedNot defined
RF (%)<2020-40>40
Structural parameters
RV size 𝜀Usually normalNormal or dilatedUsually 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

PR is found in 40-80% of peopleincorrectly constructed valve cusp(s) As a result of pulmonary hypertension.
Absence or partial absense of a valve cuspBy balloon dilatation of the PV in correction of pulmonary stenosis
Severe PR



Pulmonary stenosis is very rare.

Quantification of pulmonary stenosis

PGmax (mmHg)< 36 36 - 64> 64
Vmax (m/s)< 3 3 - 4> 4

Causes of pulmonary stenosis

Tetralogy van FallotRheumatic fever
Mild PS


European Heart Journal - Cardiovascular Imaging (2022) 23, e171–e232
European Journal of Echocardiography (2010) 11, 223?244 J Am Soc Echocardiogr. 2009 Jan;22(1):1-23