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Severe primary tricuspid regurgitation with large tunnel-shaped patent foramen ovale
  1. Behdad Bahadorian1,
  2. Majid Maleki2,
  3. Anoushiravan Vakili-Zarch1,
  4. Zahra Alizadeh-Sani1
  1. 1Department of Cardiology, Shahid Rajaie Cardiovascular Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2Department of Echocardiography, Shahid Rajaie Cardiovascular Medical Center, Tehran, Iran
  1. Correspondence to Dr Majid Maleki, Department of Echocardiography, Shahid Rajaie Cardiovascular Medical Center, Elaheyeh Ghorbansaeidi, No 13, Tehran 1964947519, Iran; majid33{at}

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A 26-year-old man presented with progressively worsening dyspnoea on exertion since the past 6 months. He was referred to our centre with the initial diagnosis of secundum type atrial septal defect and tricuspid regurgitation (see online appendix 1) based on a transthoracic echocardiography. On physical examination, he had a systolic murmur at the left sternal border with inspiratory augmentation. Electrocardiography showed normal sinus rhythm with right bundle branch block (figure 1). Chest x-ray was suggestive of right chamber enlargement with reduced pulmonary blood flow (figure 2).

Figure 1
Figure 2

Transthoracic and transoesophageal echocardiograms revealed a normal-sized left ventricle with preserved systolic function, huge right atrium, severe right ventricular (RV) enlargement with moderate …

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