Infrequent concomitant mitral, pulmonary, and tricuspid valve prolapse associated with right ventricular failure: Correct diagnosis using multimodality imaging

A 34-year-old male patient was admitted to our hospital with the symptoms of increased shortness of breath, palpitation, and exercise intolerance. The patient had no past medical history. Electrocardiography revealed atrial tachycardia. A bedside transthoracic echocardiography (TTE) indicated a markedly redundant, elongated tricuspid valve leaflet that had prolapsed into the right atrium (Video 1). Tricuspid annular plane systolic excursion was normal; however, right ventricle (RV) end-systolic area was 30.8 cm2 (Fig. 1), RV long-axis diameter was 74 mm, and RV basal diameter was 64 mm which are normal 8.6 cm2 , 67 mm, 34 mm respectively. That means severe tricuspid regurgitation (Fig. 2), causing RV dilatation. Additionally, the patient had non-holosystolic, moderate mitral regurgitation (Fig. 3) related to multi-scallop Barlow’s disease cm2 (Video 2) and had mild pulmonary insufficiency related to pulmonary valve prolapse (PVP) (Video 3).