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A 70-year-old woman with a metastatic neuroendocrine tumour presented with heart failure. A 2D transthoracic echocardiogram (TTE) showed thickened, retracted and fixed tricuspid valve (TV) leaflets with free-flowing tricuspid regurgitation (figure 1A, online supplementary videos 1 and 2), and thickened and retracted pulmonary valve (PV) cusps with severe pulmonic regurgitation (figure 1B, online supplementary video 3 and 4s). A 3D TTE en face view of the mitral valve (MV) and TV from the ventricles showed a wide-open fixed TV, while the MV opens and closes normally, giving rise to an image that simulates the heart winking at you (figure 1 …
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