FoCUS Solutions: qualitative assessment criteria for valvular stenosis and regurgitation

Valvular abnormality

Assessment criteria

Mitral valve stenosis

• Parasternal long axis view
• Apical four-chamber view

Significant (moderate-severe): abnormal valve morphology and mobility (thickened / fused leaflets / restricted mobility) with the presence of large turbulent mitral flow during diastole with or without left atrial enlargement.

Non-significant (mild): normal or abnormal valve morphology and mobility with the presence of a small turbulent mitral flow during diastole, and normal left atrial size.

Absent (none): normal valve morphology and mobility with no turbulent flow seen at the mitral valve in colour flow Doppler.

Mitral valve regurgitation

• Parasternal long axis view 
• Apical four-chamber view

Significant (moderate-severe): abnormal valve morphology and mobility (thickened / obvious coaptation defect / flail or restricted mobility) with the presence of a large central or eccentric regurgitation jet with or without left atrial and/or ventricular enlargement.

Non-significant (mild): normal or abnormal valve morphology and mobility with the presence of a small central regurgitation jet, and normal left atrial and ventricular size.

Absent (none): normal valve morphology and mobility with no regurgitation jet seen in colour flow Doppler.

Aortic valve stenosis 

• Parasternal long axis view

Significant (moderate-severe): abnormal valve morphology and mobility (thickened / fused leaflets / restricted mobility) with the presence of large turbulent aortic flow during systole with or without increased left ventricular wall thickness.

Non-significant (mild): normal or abnormal valve morphology and mobility with the presence of a small turbulent aortic flow during systole, and normal left ventricular wall thickness.

Absent (none): normal valve morphology and mobility with no turbulent flow seen at the aortic valve in colour flow Doppler.

Aortic valve regurgitation

• Parasternal long axis view

Significant (moderate-severe): abnormal valve morphology and mobility (thickened / obvious coaptation defect / flail or restricted mobility) with the presence of a large central or eccentric regurgitation jet with or without aortic root and/or left ventricular enlargement.

Non-significant (mild): normal or abnormal valve morphology and mobility with the presence of a small central regurgitation jet, and normal aortic root and left ventricular size.

Absent (none): normal valve morphology and mobility with no regurgitation jet seen in colour flow Doppler.

Tricuspid valve stenosis 

• Parasternal long axis view
• Apical four-chamber view

Significant (moderate-severe): abnormal valve morphology and mobility (thickened / fused leaflets / restricted mobility) with the presence of large turbulent tricuspid flow during diastole with or without right atrial enlargement.

Non-significant (mild): normal or abnormal valve morphology and mobility with the presence of a small turbulent tricuspid flow during diastole, and normal right atrial size.

Absent (none): normal valve morphology and mobility with no turbulent flow seen at the tricuspid valve in colour flow Doppler.

Tricuspid valve regurgitation 

• Parasternal long axis view
• Apical four-chamber view

Significant (moderate-severe): abnormal valve morphology and mobility (thickened / obvious coaptation defect / flail or restricted mobility) with the presence of a large central or eccentric regurgitation jet with or without right atrial and/or ventricular enlargement.

Non-significant (mild): normal or abnormal valve morphology and mobility with the presence of a small central regurgitation jet, and normal right atrial and ventricular size.

Absent (none): normal valve morphology and mobility with no regurgitation jet seen in colour flow Doppler.