Parachute tricuspid valve is an exceedingly rare congenital anomaly, often described in association with acyanotic heart defects. Its occurrence alongside cyanotic congenital heart disease is even less common. We report the case of a 1-year-old boy presenting with complex cyanotic heart disease along with parachute tricuspid valve. Detailed evaluation revealed a constellation of anomalies, including parachute tricuspid valve, double outlet right ventricle with D-malposed great arteries, severe pulmonary stenosis, and a non-routable ventricular septal defect. Echocardiography played a vital role in defining the complex anatomy and guided the decision toward single-ventricle palliation. This case underscores the importance of meticulous anatomical assessment in patients with congenital heart disease and contributes to the sparse literature on this rare condition.

Atrioventricular valve parachute deformity is rare and is generally seen in the mitral position, called the parachute mitral valve. It is rare to see it in the tricuspid valve and up to now, there have been approximately 14 cases of parachute abnormalities in tricuspid valves in a literature review. We present here a 21-year-old male who presented to the emergency department with progressive shortness of breath over several months. Despite the absence of chest pain, palpitations, or weight changes, examination revealed a soft, holosystolic murmur at the left lower sternal border. Further investigation through electrocardiogram and echocardiogram identified a rare structural abnormality known as parachute tricuspid valve, resulting in significant tricuspid regurgitation with mild right chamber enlargement. The patient was recommended to go abroad for further management since a cardiothoracic surgeon is not available in our country.

Parachute deformity of atrioventricular valve occurs when chordae tendineae arise either from one papillary muscle or a closely placed muscle group. Preoperative detection is easier with mitral involvement than with tricuspid valve. We present two cases of parachute tricuspid valve (PTV) which were successfully repaired.

A parachute tricuspid valve is a very rare congenital cardiac anomaly. Its morphological features and clinical implications have not been sufficiently described so far. The purpose of the present systematic review is to disclose the morphological and clinical characteristics of parachute tricuspid valve, and to discuss its diagnostic methods, treatments and patients' outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines were followed in this systematic review. Publications were systematically searched in the PubMed, Highwire Press, and the Cochrane Library databases. By comprehensive retrieval of the pertinent literature published between 1979 and 2019, 13 reports were collected with 14 patients recruited into this study. Their ages ranged from neonate to 52 years old with a median age of 23 years. Tricuspid valve regurgitation of a less-than-severe degree was seen in 6 (60%) patients, tricuspid valve stenosis was present in 3 (30%) patients and normally functioning tricuspid valve was noted in 1 (10%) patient. All patients had a single papillary muscle in the right ventricle. The chordae tendineae could be normal in length and thickness, or elongated, or shortened and thickened. Forty percent of the patients were asymptomatic or with only mild symptoms and did not need a surgical or interventional therapy, and 6 (60%) patients were indicated for a surgical/interventional treatment due to their severe presenting symptoms, associated congenital heart defects, and the resultant severe right ventricular inflow obstruction and (or) tricuspid stenosis. Patients' outcomes varied depending on the substantial status of the patients with a survival rate of 70% and mortality rate of 30%. A few patients with a parachute tricuspid valve are asymptomatic or only with mild symptoms and a surgical or interventional treatment is not required. The surgical/interventional indications for parachute tricuspid valve patients are their severe presenting symptoms, associated congenital heart defects, and the resultant severe right ventricular inflow obstruction and (or) tricuspid stenosis. The survival rate of this patient setting is satisfactory.