Figure 5: 2D Echocardiography of the 3rd case, showing good systolic function, dilated RA, RV, There was apical plaque in the right ventricle, and endomyocardial fibrous strand restricting both leaflets of the tricuspid, with a moderate to severe tricuspid regurgitation. There was also spontaneous echo contrast in RA, with evidence of pulmonary hypertension and moderate pericardial effusion