Internal view of cardiac right chambers show extreme (grade III) leaflet tethering to the ventricular wall (arrows). There is severe reduction of the functional portion of the right ventricle, the apical portion of which is tunnel-shaped chamber. The echocardiographic image shows the great predominance of the atrialized portion of the right ventricle and a perimembranous ventricular septal defect. VSD: Ventricular septal defect. Other abbreviations as before.