Rationale for remodelling annuloplasty to address functional tricuspid regurgitation during left-sided valve surgery.

The surgical management of functional tricuspid regurgitation is controversial. Functional tricuspid regurgitation is common in patients with aortic and mitral valve disease, particularly in the presence of pulmonary hypertension. The high incidence and reversibility of functional tricuspid regurgitation are due to the unique compliance of the thin right ventricular wall: modest increases in right ventricular preload, afterload, and dysfunction can result in significant functional tricuspid regurgitation. Surgical management is controversial primarily because of uncertainty over the long-term course and clinical sequelae of tricuspid regurgitation after leftsided valve surgery; and the diagnostic challenges presented by this very dynamic dysfunction.