Related Experiment Video
Updated: Jun 5, 2026

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Unique Shield: An Obstructive Huge Tricuspid Pouch Associated With Ventricular Septal Defect Developing Into
Satish Kumar Rentapalla1, Barun Kumar1, Anirudh Mukherjee1
1Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Background:
Tricuspid valve (TV) pouch is a rare entity associated with ventricular septal defect (VSD). It is even rarer to cause right ventricular (RV) inflow obstruction.
Case Summary:
A 43-year woman presented with exertional palpitations for 2 years, diagnosed with a large TV pouch causing significant RV inflow obstruction without pulmonary arterial hypertension (PAH). Cardiac magnetic resonance revealed a large perimembranous VSD with bidirectional flow into the TV pouch, which had no effective communication with the right ventricle, preventing a significant left-to-right shunt and PAH. Surgical correction involved partial excision of the pouch and closure of the VSD, preserving the TV integrity.
Discussion:
This case highlights a rare hemodynamic presentation of the TV pouch and its potential to cause RV inflow obstruction and prevent PAH in a large VSD.
Take-Home Message:
Follow-up (at least every 3-4 years) for these cases where VSDs are spontaneously closed by TV or aneurysmal membranous septum would be beneficial.
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