Table 1. Indications for pulmonary valve replacement in current guidelines.

	European Society of Cardiology (2010) 77	American College of Cardiology/American Heart Association (2008) 75	Canadian Cardiovascular Society (2009) 76
Class I	Symptomatic patients with severe PR and/or PS (RV systolic pressure >60 mm Hg, TR velocity >3.5 m/s)	Severe PR and Symptoms or decreased exercise tolerance
Class IIa	Severe PR or PS (or both) and either:	Severe PR and either:	Free PR and either:
RV size		Moderate to severe RV enlargement	EDVi 170 mL/m 2
Progression of RV size	Progressive RV dilation		Progressive RV dilation
RV function	Progressive RV dysfunction	Moderate to severe RV dysfunction	Moderate to severe RV dysfunction
TR	Progressive TR, at least moderate	Moderate to severe TR	Important TR
PS	PS RV systolic pressure greater than 80 mm Hg, TR velocity 4.3 m/s	Peak instantaneous echocardiography gradient greater than 50 mm Hg or RV/LV pressure ratio greater than 0.7 or Residual RVOT obstruction (valvular or subvalvular) with progressive and/or severe dilatation of the RV with dysfunction	RV pressure at least 2/3 systemic pressure
Exercise capacity	Decrease in objective exercise capacity		Symptoms such as deteriorating exercise performance
Arrhythmia	Sustained atrial or ventricular arrhythmia	Symptomatic or sustained atrial and/or ventricular arrhythmias	Atrial or ventricular arrhythmia

EDVi, end-diastolic volume index; LV, left ventricle; PR, pulmonary regurgitation; PS, pulmonary stenosis; RV, right ventricle; RVOT, right ventricle outflow tract; TR, tricuspid regurgitation.