A 51-year-old unrestrained female driver with history of a high-speed motor vehicle accident had been followed due to progressively worsening tricuspid valve regurgitation (TR). Three dimensional (3D0 transesophageal echocardiogram (TEE) showed a TR jet through a perforation in the an avulsed anterior leaflet from the tricuspid valve and another central tricuspid TR jet regurgitation due to tricuspid leafletresulted from malcoaptation of the leaflets from tricuspid annulus annular dilatation.