Uncommon Doppler Echocardiographic Findings of Severe Pulmonic Insufficiency

The published criteria do not include in detail the subtle signs of severe PI such as (1) holodiastolic flow reversal in the pulmonary artery, (2) PI with laminar retrograde flow, (3) premature opening of the pulmonic valve, (4) very low peak velocity of the PI jet, and (5) premature closure of the tricuspid valve. These signs should be considered in the grading of PI severity in addition to the existing guidelines criteria.