2012 WHF criteria for echocardiographic diagnosis of RHD for individuals aged ≤20 years7
| Definite RHD (either A, B, C or D) | |
| (A) Pathological MR and at least two morphological features of RHD of the MV | |
| (B) MS mean gradient ≥4 mm Hg* | |
| (C) Pathological AR and at least two morphological features of RHD of the AV† | |
| (D) Borderline disease of both the AV and MV‡ | |
| Borderline RHD (either A, Bor C) | |
| (A) At least two morphological features of RHD of the MV without pathological MR or MS | |
| (B) Pathological MR | |
| (C) Pathological AR | |
| Normal echocardiographic findings (all of A, B, Cand D) | |
| (A) MR that does not meet all four Doppler echocardiographic criteria (physiological MR) | |
| (B) AR that does not meet all four Doppler echocardiographic criteria (physiological AR) | |
| (C) An isolated morphological feature of RHD of the MV (eg, valvular thickening) without any associated pathological stenosis or regurgitation | |
| (D) Morphological feature of RHD of the AV (eg, valvular thickening) without any associated pathological stenosis or regurgitation | |
| Pathological mitral regurgitation (all four Doppler criteria must be met) | Pathological aortic regurgitation (all four Doppler criteria must be met) |
| Seen in two views | Seen in two views |
| In at least one view, jet length ≥2 cm | In at least one view, jet length ≥1 cm |
| Velocity ≥3 m/s for one complete envelope | Velocity ≥3 m/s in early diastole |
| Pan-systolic jet in at least one envelope | Pan-diastolic jet in at least one envelope |
| Morphological features of the MV | Morphological features of the AV |
| AMVL thickening ≥3 mm | Irregular or focal thickening |
| Chordal thickening | Coaptation defect |
| Restricted leaflet motion | Restricted leaflet motion |
| Excessive leaflet tip motion during systole | Prolapse |
*Congenital MV anomalies must be excluded.
†Bicuspid AV, dilated aortic root and hypertension must be excluded.
‡Combined AR and MR in high-prevalence regions and in the absence of congenital heart disease is regarded as rheumatic.
AMVL, anterior mitral valve leaflet; AR, aortic regurgitation;AV, aortic valve;MR, mitral regurgitation;MS, mitral stenosis;MV, mitral valve;RHD, rheumatic heart disease;WHF, World Heart Federation.