Journal of the American Society of Echocardiography
Volume 16, Issue 7 , Pages 777-802 , July 2003

Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography

  • William A Zoghbi, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Maurice Enriquez-Sarano, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Elyse Foster, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Paul A Grayburn, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Carol D Kraft, RDMS

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Robert A Levine, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Petros Nihoyannopoulos, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Catherine M Otto, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Miguel A Quinones, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Harry Rakowski, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • William J Stewart, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Alan Waggoner, MHS, RDMS

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:
    • ,
  • Neil J Weissman, MD

      Affiliations

    • A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee Council on Clinical Cardiology, the American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by:

References 

  1. Bonow RO, Carabello B, de LA, Edmunds LH, Fedderly BJ, Freed MD, et al.  Guidelines for the management of patients with valvular heart disease (executive summary; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease)). Circulation. 1998;98:1949–1984
  2. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography (American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms). J Am Soc Echocardiogr. 1989;2:358–367
  3. Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography (a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography). J Am Soc Echocardiogr. 2002;15:167–184
  4. Sahn DJ. Instrumentation and physical factors related to visualization of stenotic and regurgitant jets by Doppler color flow mapping. J Am Coll Cardiol. 1988;12:1354–1365
  5. Baumgartner H, Schima H, Kuhn P. Value and limitations of proximal jet dimensions for the quantitation of valvular regurgitation (an in vitro study using Doppler flow imaging). J Am Soc Echocardiogr. 1991;4:57–66
  6. Kizilbash AM, Willett DL, Brickner ME, Heinle SK, Grayburn PA. Effects of afterload reduction on vena contracta width in mitral regurgitation. J Am Coll Cardiol. 1998;32:427–431
  7. Bargiggia GS, Tronconi L, Sahn DJ, Recusani F, Raisaro A, De Servi S, et al.  A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice. Circulation. 1991;84:1481–1489
  8. Utsunomiya T, Doshi R, Patel D, Mehta K, Nguyen D, Henry WL, et al.  Calculation of volume flow rate by the proximal isovelocity surface area method (simplified approach using color Doppler zero baseline shift). J Am Coll Cardiol. 1993;22:277–282
  9. Pu M, Vandervoort PM, Griffin BP, Leung DY, Stewart WJ, Cosgrove DM, et al.  Quantification of mitral regurgitation by the proximal convergence method using transesophageal echocardiography (clinical validation of a geometric correction for proximal flow constraint). Circulation. 1995;92:2169–2177
  10. Simpson IA, Shiota T, Gharib M, Sahn DJ. Current status of flow convergence for clinical applications (is it a leaning tower of “PISA”?). J Am Coll Cardiol. 1996;27:504–509
  11. Sitges M, Jones M, Shiota T, Prior DL, Qin JX, Tsujino H, et al.  Interaliasing distance of the flow convergence surface for determining mitral regurgitant volume (a validation study in a chronic animal model). J Am Coll Cardiol. 2001;38:1195–1202
  12. Schwammenthal E, Chen C, Benning F, Block M, Breithardt G, Levine RA. Dynamics of mitral regurgitant flow and orifice area (physiologic application of the proximal flow convergence method; clinical data and experimental testing). Circulation. 1994;90:307–322
  13. Lewis JF, Kuo LC, Nelson JG, Limacher MC, Quiñones MA. Pulsed Doppler echocardiographic determination of stroke volume and cardiac output (clinical validation of two new methods using the apical window). Circulation. 1984;70:425–431
  14. Rokey R, Sterling LL, Zoghbi WA, Sartori MP, Limacher MC, Kuo LC, et al.  Determination of regurgitant fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography. J Am Coll Cardiol. 1986;7:1273–1278
  15. Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ, Krohn MJ, Mays JM. Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993;87:841–848
  16. Hundley WG, Kizilbash AM, Afridi I, Franco F, Peshock RM, Grayburn PA. Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction (comparison with cine magnetic resonance imaging). J Am Coll Cardiol. 1998;32:1426–1432
  17. Thomson HL, Basmadjian AJ, Rainbird AJ, Razavi M, Avierinos JF, Pellikka PA, et al.  Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements (a prospective, randomly assigned, blinded study). J Am Coll Cardiol. 2001;38:867–875
  18. Smith MD, Cassidy JM, Gurley JC, Smith AC, Booth DC. Echo Doppler evaluation of patients with acute mitral regurgitation (superiority of transesophageal echocardiography with color flow imaging). Am Heart J. 1995;129:967–974
  19. Khoury AF, Afridi I, Quiñones MA, Zoghbi WA. Transesophageal echocardiography in critically ill patients (feasibility, safety, and impact on management). Am Heart J. 1994;127:1363–1371
  20. Cape EG, Yoganathan AP, Levine RA. Increased heart rate can cause underestimation of regurgitant jet size by Doppler color flow mapping. J Am Coll Cardiol. 1993;21:1029–1037
  21. Thomas JD, Liu CM, Flachskampf FA, O’Shea JP, Davidoff R, Weyman AE. Quantification of jet flow by momentum analysis (an in vitro color Doppler flow study). Circulation. 1990;81:247–259
  22. Cape EG, Skoufis EG, Weyman AE, Yoganathan AP, Levine RA. A new method for noninvasive quantification of valvular regurgitation based on conservation of momentum (in vitro validation). Circulation. 1989;79:1343–1353
  23. Oh JK, Seward JB, Khandheria BK, Gershe BJ, McGregor CGA, Freeman WK, et al.  Transesophageal echocardiography in critically ill patients. Am J Cardiol. 1990;66:1492–1495
  24. Honey M, Gough SH, Katsaros S, Miller GAH, Thuraisingham V. Left ventricular cine-angiocardiography in the assessment of mitral regurgitation. Br Heart J. 1969;31:596–602
  25. Baron MG. Angiocardiographic evaluation of valvular insufficiency. Circulation. 1971;43:599–605
  26. Sandler H, Dodge HT, Hay RE, Rackley CE. Quantification of valvular insufficiency in man by angiocardiography. Am Heart J. 1963;65:501–513
  27. Lopez JF, Hanson S, Orchard RC, Tan L. Quantification of mitral valvular incompetence. Cathet Cardiovasc Diagn. 1985;11:139–152
  28. Hunt D, Baxley WA, Kennedy JW, Judge TP, Williams JE, Dodge HT. Quantitative evaluation of cineaortography in the assessment of aortic regurgitation. Am J Cardiol. 1973;31:696–700
  29. Stewart WJ, Currie PJ, Salcedo EE, Lytle BW, Gill CC, Schiavone WA, et al.  Intraoperative Doppler color flow mapping for decision-making in valve repair for mitral regurgitation (technique and results in 100 patients). Circulation. 1990;81:556–566
  30. Stewart WJ, Salcedo EE, Cosgrove DM. The value of echocardiography in mitral valve repair. Cleve Clin J Med. 1991;58:177–183
  31. Otsuji Y, Handschumacher MD, Schwammenthal E, Jiang L, Song J, Guerrero JL, et al.  Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation (direct in vivo demonstration of altered leaflet tethering geometry). Circulation. 1997;96:1999–2008
  32. Carabello BA, Crawford FA. Valvular heart disease. N Engl J Med. 1997;337:32–41
  33. Echocardiographic measurements and normal values. In: Feigenbaum H, editor. Echocardiography. Philadelphia: Lea & Febiger; 1994. p. 658-83
  34. Lester SJ, Ryan EW, Schiller NB, Foster E. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol. 1999;84:829–832
  35. Wang Y, Gutman JM, Heilbron D, Wahr D, Schiller NB. Atrial volume in a normal adult population by two-dimensional echocardiography. Chest. 1984;86:595–601
  36. Yoshida K, Yoshikawa J, Shakudo M, Akasaka T, Jyo Y, Takao S, et al.  Color Doppler evaluation of valvular regurgitation in normal subjects. Circulation. 1988;78:840–847
  37. Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, et al.  Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation. 1987;75:175–183
  38. Cape EG, Yoganathan AP, Weyman AE, Levine RA. Adjacent solid boundaries alter the size of regurgitant jets on Doppler color flow maps. J Am Coll Cardiol. 1991;17:1094–1102
  39. Chen C, Thomas JD, Anconina J, Harrigan P, Mueller L, Picard MH, et al.  Impact of impinging wall jet on color Doppler quantification of mitral regurgitation. Circulation. 1991;84:712–720
  40. Enriquez-Sarano M, Tajik AJ, Bailey KR, Seward JB. Color flow imaging compared with quantitative Doppler assessment of severity of mitral regurgitation (influence of eccentricity of jet and mechanism of regurgitation). J Am Coll Cardiol. 1993;21:1211–1229
  41. Fehske W, Omran H, Manz M, Kohler J, Hagendorff A, Luderitz B. Color-coded Doppler imaging of the vena contracta as a basis for quantification of pure mitral regurgitation. Am J Cardiol. 1994;73:268–274
  42. Hall SA, Brickner ME, Willett DL, Irani WN, Afridi I, Grayburn PA. Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. Circulation. 1997;95:636–642
  43. Heinle SK, Hall SA, Brickner ME, Willett DL, Grayburn PA. Comparison of vena contracta width by multiplane transesophageal echocardiography with quantitative Doppler assessment of mitral regurgitation. Am J Cardiol. 1998;81:175–179
  44. Tribouilloy C, Shen WF, Quere JP, Rey JL, Choquet D, Dufosse H, et al.  Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging. Circulation. 1992;85:1248–1253
  45. Mele D, Vandervoort P, Palacios I, Rivera JM, Dinsmore RE, Schwammenthal E, et al.  Proximal jet size by Doppler color flow mapping predicts severity of mitral regurgitation (clinical studies). Circulation. 1995;91:746–754
  46. Enriquez-Sarano M, Miller FA, Hayes SN, Bailey KR, Tajik AJ, Seward JB. Effective mitral regurgitant orifice area (clinical use and pitfalls of the proximal isovelocity surface area method). J Am Coll Cardiol. 1995;25:703–709
  47. Pu M, Prior DL, Fan X, Asher CR, Vasquez C, Griffin BP, et al.  Calculation of mitral regurgitant orifice area with use of a simplified proximal convergence method (initial clinical application). J Am Soc Echocardiogr. 2001;14:180–185
  48. Hopmeyer J, He S, Thorvig KM, McNeil E, Wilkerson PW, Levine RA, et al.  Estimation of mitral regurgitation with a hemielliptic curve-fitting algorithm (in vitro experiments with native mitral valves). J Am Soc Echocardiogr. 1998;11:322–331
  49. Schwammenthal E, Chen C, Giesler M, Sagie A, Guerrero JL, Vazquez de Prada JA, et al.  New method for accurate calculation of regurgitant flow rate based on analysis of Doppler color flow maps of the proximal flow field (validation in a canine model of mitral regurgitation with initial application in patients). J Am Coll Cardiol. 1996;27:161–172
  50. Mele D, Schwammenthal E, Torp H, Nesta F, Pedini I, Vandervoort P, et al.  A semiautomated objective technique for applying the proximal isovelocity surface area method to quantitate mitral regurgitation (clinical studies with the digital flow map). Am Heart J. 2001;141:653–660
  51. Buck T, Mucci RA, Guerrero JL, Holmvang G, Handschumacher MD, Levine RA. The power-velocity integral at the vena contracta (a new method for direct quantification of regurgitant volume flow). Circulation. 2000;102:1053–1061
  52. Thomas L, Foster E, Schiller NB. Peak mitral inflow velocity predicts mitral regurgitation severity. J Am Coll Cardiol. 1998;31:174–179
  53. Enriquez-Sarano M, Seward JB, Bailey KR, Tajik AJ. Effective regurgitant orifice area (a noninvasive Doppler development of an old hemodynamic concept). J Am Coll Cardiol. 1994;23:443–451
  54. Dujardin KS, Enriquez-Sarano M, Bailey KR, Nishimura RA, Seward JB, Tajik AJ. Grading of mitral regurgitation by quantitative Doppler echocardiography (calibration by left ventricular angiography in routine clinical practice). Circulation. 1997;96:3409–3415
  55. Kizilbash AM, Hundley WG, Willett DL, Franco F, Peshock RM, Grayburn PA. Comparison of quantitative Doppler with magnetic resonance imaging for assessment of the severity of mitral regurgitation. Am J Cardiol. 1998;81:792–795
  56. Pu M, Griffin BP, Vandervoort PM, Stewart WJ, Fan X, Cosgrove DM, et al.  The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation (a quantitative assessment integrating left ventricular function). J Am Soc Echocardiogr. 1999;12:736–743
  57. Thomas L, Foster E, Hoffman JI, Schiller NB. The mitral regurgitation index (an echocardiographic guide to severity). J Am Coll Cardiol. 1999;33:2016–2022
  58. Grayburn PA, Smith MD, Handshoe R, Friedman BJ, DeMaria AN. Detection of aortic insufficiency by standard echocardiography, pulsed Doppler echocardiography, and auscultation (a comparison of accuracies). Ann Intern Med. 1986;104:599–605
  59. Perry GJ, Helmcke F, Nanda NC, Byard C, Soto B. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol. 1987;9:952–959
  60. Reynolds T, Abate J, Tenney A, Warner MG. The JH/LVOH method in the quantification of aortic regurgitation (how the cardiac sonographer may avoid an important potential pitfall). J Am Soc Echocardiogr. 1991;4:105–108
  61. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ. Assessment of severity of aortic regurgitation using the width of the vena contracta (a clinical color Doppler imaging study). Circulation. 2000;102:558–564
  62. Taylor AL, Eichhorn EJ, Brickner ME, Eberhart RC, Grayburn PA. Aortic valve morphology (an important in vitro determinant of proximal regurgitant jet width by Doppler color flow mapping). J Am Coll Cardiol. 1990;16:405–412
  63. Tribouilloy CM, Enriquez-Sarano M, Fett SL, Bailey KR, Seward JB, Tajik AJ. Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation. J Am Coll Cardiol. 1998;32:1032–1039
  64. Touche T, Prasquier R, Nitenberg A, de Zuttere D, Gourgon R. Assessment and follow-up of patients with aortic regurgitation by an updated Doppler echocardiographic measurement of the regurgitant fraction in the aortic arch. Circulation. 1985;72:819–824
  65. Tribouilloy C, Avinee P, Shen WF, Rey JL, Slama M, Lesbre JP. End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography (a new predictor of the aortic regurgitant fraction). Br Heart J. 1991;65:37–40
  66. Teague SM, Heinsimer JA, Anderson JL, Sublett K, Olson EG, Voyles WF, et al.  Quantification of aortic regurgitation utilizing continuous wave Doppler ultrasound. J Am Coll Cardiol. 1986;8:592–599
  67. Padial LR, Oliver A, Vivaldi M, Sagie A, Freitas N, Weyman AE, et al.  Doppler echocardiographic assessment of progression of aortic regurgitation. Am J Cardiol. 1997;80:306–314
  68. Griffin BP, Flachskampf FA, Siu S, Weyman AE, Thomas JD. The effects of regurgitant orifice size, chamber compliance, and systemic vascular resistance on aortic regurgitant velocity slope and pressure half-time. Am Heart J. 1991;122:1049–1056
  69. Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, et al.  Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83:897–902
  70. Lavie CJ, Hebert K, Cassidy M. Prevalence and severity of Doppler-detected valvular regurgitation and estimation of right-sided cardiac pressures in patients with normal two-dimensional echocardiograms. Chest. 1993;103:226–231
  71. Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Taliercio CP, Taylor CL, et al.  Age-related prevalence of valvular regurgitation in normal subjects (a comprehensive color flow examination of 118 volunteers). J Am Soc Echocardiogr. 1990;3:54–63
  72. Hansing CE, Rowe GG. Tricuspid insufficiency (a study of hemodynamics and pathogenesis). Circulation. 1972;45:793–799
  73. Cohen SR, Sell JE, McIntosh CL, Clark RE. Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation (II, nonoperative management, tricuspid valve annuloplasty, and tricuspid valve replacement). J Thorac Cardiovasc Surg. 1987;94:488–497
  74. Waller BF, Howard J, Fess S. Pathology of tricuspid valve stenosis and pure tricuspid regurgitation–part III. Clin Cardiol. 1995;18:225–230
  75. Veyrat C, Kalmanson D, Farjon M, Manin JP, Abitbol G. Non-invasive diagnosis and assessment of tricuspid regurgitation and stenosis using one and two dimensional echo-pulsed Doppler. Br Heart J. 1982;47:596–605
  76. Miyatake K, Okamoto M, Kinoshita N, Ohta M, Kozuka T, Sakakibara H, et al.  Evaluation of tricuspid regurgitation by pulsed Doppler and two dimensional echocardiography. Circulation. 1982;66:777–784
  77. DePace NL, Ross J, Iskandrian AS, Nestico PF, Kotler MN, Mintz GS, et al.  Tricuspid regurgitation (noninvasive techniques for determining causes and severity). J Am Coll Cardiol. 1984;3:1540–1550
  78. Sakai K, Nakamura K, Satomi G, Kondo M, Hirosawa K. Hepatic vein blood flow pattern measured by Doppler echocardiography as an evaluation of tricuspid valve insufficiency. J Cardiogr. 1983;13:33–43
  79. Simonson JS, Schiller NB. Sonospirometry (a non-invasive method for estimation of mean right atrial pressure based on two dimensional echocardiographic measurements of the inferior vena cava during measured inspiration). J Am Coll Cardiol. 1988;11:557–564
  80. Abu-Yousef MM. Duplex Doppler sonography of the hepatic vein in tricuspid regurgitation. AJR Am J Roentgenol. 1991;156:79–83
  81. Grossmann G, Stein M, Kochs M, Hoher M, Koenig W, Hombach V, et al.  Comparison of the proximal flow convergence method and the jet area method for the assessment of the severity of tricuspid regurgitation. Eur Heart J. 1998;19:652–659
  82. Shapira Y, Porter A, Wurzel M, Vaturi M, Sagie A. Evaluation of tricuspid regurgitation severity (echocardiographic and clinical correlation). J Am Soc Echocardiogr. 1998;11:652–659
  83. Gonzalez-Vilchez F, Zarauza J, Vazquez de Prada JA, Martin DR, Ruano J, Delgado C, et al.  Assessment of tricuspid regurgitation by Doppler color flow imaging (angiographic correlation). Int J Cardiol. 1994;44:275–283
  84. Yamachika S, Reid CL, Savani D, Meckel C, Paynter J, Knoll M, et al.  Usefulness of color Doppler proximal isovelocity surface area method in quantitating valvular regurgitation. J Am Soc Echocardiogr. 1997;10:159–168
  85. Rivera JM, Vandervoort P, Mele D, Weyman A, Thomas JD. Value of proximal regurgitant jet size in tricuspid regurgitation. Am Heart J. 1996;131:742–747
  86. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Tajik AJ, Seward JB. Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging (a clinical study). J Am Coll Cardiol. 2000;36:472–478
  87. Minagoe S, Rahimtoola SH, Chandraratna PA. Significance of laminar systolic regurgitant flow in patients with tricuspid regurgitation (a combined pulsed-wave, continuous-wave Doppler and two-dimensional echocardiographic study). Am Heart J. 1990;119:627–635
  88. Nagueh SF, Kopelen HA, Zoghbi WA. Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function. Circulation. 1996;93:1160–1169
  89. Normal cross-sectional echocardiographic measurements. In: Weyman A, editor. Principles and practice of echocardiography. Phildelphia: Lea & Febiger; 1994. p. 1289-98
  90. Choong CY, Abascal VM, Weyman J, Levine RA, Gentile F, Thomas JD, et al.  Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography. Am Heart J. 1989;117:636–642
  91. Takao S, Miyatake K, Izumi S, Okamoto M, Kinoshita N, Nakagawa H, et al.  Clinical implications of pulmonary regurgitation in healthy individuals (detection by cross sectional pulsed Doppler echocardiography). Br Heart J. 1988;59:542–550
  92. Kobayashi J, Nakano S, Matsuda H, Arisawa J, Kawashima Y. Quantitative evaluation of pulmonary regurgitation after repair of tetralogy of Fallot using real-time flow imaging system. Jpn Circ J. 1989;53:721–727
  93. Tweddell JS, Pelech AN, Frommelt PC, Mussatto KA, Wyman JD, Fedderly RT, et al.  Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation. 2000;102:III130–135
  94. Waggoner AD, Quinones MA, Young JB, Brandon TA, Shah AA, Verani MS, et al.  Pulsed Doppler echocardiographic detection of right-sided valve regurgitation (experimental results and clinical significance). Am J Cardiol. 1981;47:279–286
  95. Goldberg SJ, Allen HD. Quantitative assessment by Doppler echocardiography of pulmonary or aortic regurgitation. Am J Cardiol. 1985;56:131–135
  96. Marx GR, Hicks RW, Allen HD, Goldberg SJ. Noninvasive assessment of hemodynamic responses to exercise in pulmonary regurgitation after operations to correct pulmonary outflow obstruction. Am J Cardiol. 1988;61:595–601
  97. Lei MH, Chen JJ, Ko YL, Cheng JJ, Kuan P, Lien WP. Reappraisal of quantitative evaluation of pulmonary regurgitation and estimation of pulmonary artery pressure by continuous wave Doppler echocardiography. Cardiology. 1995;86:249–256
  98. Zoghbi WA, Farmer KL, Soto JG, Nelson JG, Quiñones MA. Accurate noninvasive quantification of stenotic aortic valve area by Doppler echocardiography. Circulation. 1986;73:452–459
  99. Nakatani S, Masuyama T, Kodama K, Kitabatake A, Fujii K, Kamada T. Value and limitations of Doppler echocardiography in the quantification of stenotic mitral valve area (comparison of the pressure half-time and the continuity equation methods). Circulation. 1988;77:78–85

☆ These recommendations are endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC). Representative from the ACC Echocardiography Committee: Elyse Foster, MD; representative from the Cardiac Imaging Committee, Council on Clinical Cardiology, AHA: Miguel A. Quinones, MD; representative from the ESC Working Group on Echocardiography: Petros Nihoyannopoulos, MD.Copyright 2003 American Society of Echocardiography, Property of ASE. Reprint of these documents, beyond single use, is prohibited without the prior written authorization of the ASE. Illustrative cases of valvular regurgitation are available on the Web site of the American Society of Echocardiography at www.aseuniversity.org/valveregurgitation.html. Address document reprint requests to the American Society of Echocardiography, 1500 Sunday Drive, Suite 102, Raleigh, NC 27607, phone: (919) 787-5181.

PII: S0894-7317(03)00335-3

doi: 10.1016/S0894-7317(03)00335-3

Journal of the American Society of Echocardiography
Volume 16, Issue 7 , Pages 777-802 , July 2003

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