Pulsus paradoxus in a patient with tricuspid atresia and hypoplastic right heart

Increased inspiratory right ventricular filling with a consequent shift of the ventricular septum to the left, thereby decreasing left ventricular filling, has been suggested as a mechanism of pulsus paradoxus. We recently saw a patient with tricuspid atresia and hypoplastic right ventricle who developed pulsus paradoxus. His course may help clarify the contribution of this mechanism.