Grading the severity of TR 


 Parameters Mild Moderate Severe
   Mitral valve morphology Normal/Abnormal Normal/Abnormal Flail lefleat/ruptured PMs
   Colour flow MR jet Small, central Intermediate Very large central jet or eccentric jet adhering, swirling and reaching the posterior wall of the LA
   Flow convergence zone No or small Intermediate Large
   CW signal of MR jet Faint/Parabolic Dense/Parabolic


   VC width (mm) <3 Intermediate ≥7 (>8 for biplane)
   Pulmonary vein flow Systolic dominance Systolic blunting Systolic flow reversal
   Mitral inflow A wave dominant Variable E wave dominant (>1.5 cm/s)
   TVI mit /TVI Ao <1 Intermediate >1.4
   EROA (mm²) <20 20-29; 30-39 ≥40
   R vol (mL) <30 30-44; 45-59 ≥60 
+LV and LA size and the systolic pulmonary pressure