The tricuspid valve (TV) is very often neglected in routine echocardiographic examination. It is important to understand that tricuspid value dysfunction is influential in patient outcomes (1). The most often seen TV pathology is tricuspid regurgitation (TR). The presence of mild TR is physiologic in 65-100% of the population (2). More than mild regurgitation is suspicious for tricuspid valve disease. Functional TR is the most frequent etiology. It is secondary to poor tricuspid leaflets coaptation due to dilatation of tricuspid annulus and right chambers secondary to left sided heart disease or pulmonary disease (3). Organic tricuspid valve disease (regurgitation or stenosis) can be due to rheumatic heart disease, endocarditis, carcinoid heart disease or congenital heart disease. The presence of pacemaker or intracardiac defibrillator, as well as repeated right ventricle biopsies in transplanted patients can lead to tricuspid trauma and TR³. Functional TR, resulting from left sided disease, can be significantly influenced by hemodynamic factors, and most often would not resolve after correction of the underlying pathology.

It is essential to preform TV evaluation (morphology and function) in patients planed for cardiac surgery on a high quality transthoracic echocardiography and make decision whether TV warrants operative attention (4). Whilst the surgical management at the extremes of TR (mild or severe) is relatively clear, the ideal intervention in intermediate grades, especially during concurrent left sided surgery remains uncertain and is the subject of ongoing research.