Two cases of parachute tricuspid valve confirmed by three-dimensional echocardiography

Parachute tricuspid valve is a rare congenital malformations explained in the literature. In most cases, this malformation coexists with other congenital defects. The importance of this condition depends on its functional consequences.

First case was a 52-year-old female patient presented with palpitation. She had a history of paroxysmal supraventricular tachycardia. Transthoracic echocardiography revealed large secundum type atrial septal defect and all the tricuspid valve leaflets appeared to be connected to a single calcified papillary muscle in right ventricle suggestive of parachute tricuspid valve. Echocardiography showed severe right ventricle and right atrial enlargement, and moderate to severe tricuspid regurgitation without significant tricuspid stenosis. Another case was a 30-year-old female patient referred for echocardiography prior to her breast cancer chemotherapy. Transthoracic echocardiography revealed a right ventricle with an unusual fusion of papillary muscles resulting in a single calcified head for the attachment of all tricuspid leaflets. These findings were suggestive of a parachute-like tricuspid valve. Other data were mild to moderate tricuspid regurgitation without any stenosis, and normal right ventricle size and function. In both cases, parachute tricuspid valve was confirmed by three dimensional echocardiograph.

In our first case, parachute tricuspid valve was associated with atrial septal defect, although in the second case, no associated anomaly was detected, a condition not previously reported in the literature. In both cases, parachute tricuspid valve was not associated with tricuspid stenosis. Based on other published cases, parachute involvement of the tricuspid valve is less often reported than cases involving the mitral valve. Additionally, the associated consequences in tricuspid valve position such as tricuspid stenosis seem to be less significant than cases involving mitral valve. It is recommended that in patients with tricuspid valve involvement, parachute anomaly should be considered as a possible rare cause.