very old patient with peripheral oedema and dyspnoea. no underlaying diseases are known.
In TTE I could see a massive RA and RV dilatation with distinct tethering and tenting of tricuspid valve caused by RV dilatation. There is no coadaption of anterior and septale tricuspid cusps. PAPs was about 55 mmHg, I think the PAPs is very underexistimated by bernulli formula because of low RV function (TAPSE 8 mm, however the midventricular free RV wall seems to work better).