The pulmonary valve is the smallest of four cardiac valves and is the least studied valve during echocardiographic imaging. It surmounts the infundibulum and is situated in a different plane at some distance from the other three cardiac valves. The general plane of the valve faces superiorly to the left and slightly posteriorly. It has three semilunar cusps named right, left, and anterior (nonseptal). Major differences from the aortic valve are lighter construction of valve cusps, absence of coronary artery origins, and normal lack of fibrous continuity with the anterior tricuspid valve leaflet. Absent pulmonary valve is a rare anomaly resulting in unguarded and usually narrowed pulmonary annulus. It may be seen along with TOF or may occur with intact ventricular septum. Instead of the pulmonary valve, an echo-bright fibrous tissue is seen at the site of the annulus.