Echocardiographic Criteria for Pulmonic Stenosis

Severity Classification

• The European Society of Cardiology recommends classifying pulmonic stenosis severity by Doppler peak jet velocity and mean gradient: mild (<3 m/s or <36 mmHg), moderate (3-4 m/s or 36-64 mmHg), and severe (>4 m/s or >64 mmHg) 1
• The American College of Cardiology suggests that severe stenosis is characterized by a peak velocity >4 m/s (peak gradient >64 mmHg) 1, 2

Qualitative and Morphologic Features

• The European Heart Society recommends assessing valve morphology for thickened, dysplastic leaflets, doming or fusion of valve cusps, and restricted leaflet mobility 1, 4
• Right ventricular hypertrophy can be measured by assessing anterior RV wall thickness as a marker of chronic pressure overload 1

Important Technical Considerations and Pitfalls

• The European Society of Cardiology notes that Doppler gradients can overestimate severity in patients with tubular stenosis or multiple levels of obstruction (subvalvular and valvular stenoses in series) 1
• The American College of Cardiology recommends correlating Doppler gradients with TR velocity to estimate true RV systolic pressure 1

Prosthetic Pulmonary Valve Criteria

• The European Heart Society suggests that for patients with pulmonary valve prostheses, different thresholds apply, including bioprosthesis obstruction (peak velocity ≥3.2 m/s or mean gradient ≥20 mmHg) and homograft obstruction (peak velocity ≥2.5 m/s or mean gradient ≥15 mmHg) 3

Clinical Correlation Required

• The American College of Cardiology recommends that the echocardiogram should never be interpreted in isolation but must be integrated with clinical findings, including physical examination, symptoms, and ECG findings 6
• The European Society of Cardiology notes that symptoms such as dyspnea, reduced exercise capacity, syncope, or presyncope suggest hemodynamically significant stenosis 4, 5