The spectrum of leaflet tethering from mild to extreme with varying degrees of tricuspid regurgitation were documented by echocardiography in a 16-year old cyanotic male with Ebstein's anomaly associated with an atrial septal defect and mild low tricuspid regurgitation (TR), 22-year old acyanotic male with right-sided heart failure due to severe tricuspid regurgitation and an intact atrial septum, 55-year old aymptomatic female with moderate high tricuspid regurgitation. The extreme form was described as an 'atretic' membrane in a 28-year old cyanotic male and as a 'blanket' of leaflet tissue in a 30-year old cyanotic male.