Figure 3A: 2DE in the apical 4-chamber view shows a large atrialized component of the right ventricle with an elongated (sail-like), mobile anterior tricuspid valve leaflet (TV) (red arrows). The septal leaflet (white arrows) appears plastered to the septum and displaced towards the right ventricular apex. The septal TV is inserted 3.2 cm lower than the anterior mitral leaflet. There is gross lack of systolic coaptation of the TV leaflets causing severe tricuspid regurgitation (white arrows, Fig 3B). There was no ASD by color Doppler and cardiac catheterization. Figure 3C: Peripheral contrast injection with agitated saline showed moderate right to left contrast shunting at atrial level indicative of patent foramen ovale (PFO).