figure 1. A two-dimensional fetal echocardiogram (a-c) with localized areas of increased echogenicity at the papillary muscles of both AV valves. The last fetal echocardiogram (c) showed minimal residual echo bright density limited to the tricuspid valve (arrow). Postnatal echocardiogram showed the tricuspid valve with an image resembling vegetation (asterisk) and, by color-flow Doppler, severe insufficiency of the tricuspid valve (d-e). RV: right ventricle. RA: right atrium. LV: left ventricle. LA: left atrium.

figure 2. Transthoracic (a-b) and transesophageal echocardiogram (c-d) showed a flail of the anterior leaflet of the tricuspid valve (asterisk) with severe regurgitation and dilatation of the right ventricular cavities. Transesophageal postoperative images showing the normal alignment of the tricuspid valve and mild regurgitation (e-f). RV: right ventricle. RA: right atrium. LV: left ventricle. LA: left atrium.