Which option best represents the indirect signs used to assess the severity of pulmonary regurgitation?

• A. PR jet width
• B. All of the above
• C. Deceleration slope of PR signal
• D. Diastolic flow reversal into the pulmonary arteries

Answer: (B)

In pulmonary regurgitation, indirect signs of severity reflect the downstream hemodynamic impact rather than just the direct appearance of the regurgitant jet. The diastolic flow reversal in the pulmonary arteries is a classic, strong indicator: when regurgitation is significant, blood flows backward into the Pulmonary artery during diastole, producing a detectable reversed flow pattern that correlates with worse PR. The deceleration slope of the PR Doppler signal provides information about how the regurgitant jet loses velocity during diastole; a steeper or more abrupt slope tends to accompany larger regurgitant volumes and greater severity, offering a waveform-based surrogate when the jet itself is hard to quantify. Jet width, while a direct measure of the jet itself, also contributes to the overall assessment because a wider jet generally corresponds to more regurgitant flow and worse regurgitation, especially when used in conjunction with downstream signs. Taken together, these features—diastolic flow reversal, the PR Doppler waveform deceleration, and jet width—form a set of indirect signs that help gauge severity, making all of the listed signs useful in an integrated evaluation.