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This editorial refers to ‘Geometric changes after tricuspid annuloplasty and predictors of residual tricuspid regurgitation: a real-time three-dimensional echocardiography study’, by S.-Y. Min et al. doi:10.1093/eurheartj/ehq227 Only limited information is currently available about the prognostic significance of tricuspid regurgitation (TR). The few existing studies, however, suggest a strong impact of TR on clinical outcome. Significant TR is associated with poor prognosis in patients with mitral stenosis after percutaneous balloon valvuloplasty1 and with a reduction in exercise capacity after mitral valve surgery.2 A significant increase in mortality among patients with moderate and severe TR has been reported, which was independent of left ventricular ejection fraction or pulmonary artery pressure.3 In 60 patients with flail tricuspid leaflet due to trauma, significant increases in atrial fibrillation, heart failure, and death were observed.4 TR was also an independent predictor of increased mortality in 1400 patients with left ventricular systolic dysfunction.5TR is only rarely caused by primary abnormalities of the tricuspid leaflets. In most instances it is ‘functional’ in nature and is the consequence of geometric alterations caused by right ventricular dilatation,6,7 distortion of the subvalvular apparatus, tricuspid annular dilatation, or a combination … *Corresponding athor. Tel: +43 1 40 400 4614, Fax: +43 1 40400 4216, E-mail: gerald.maurer{at}meduniwien.ac.at

The forgotten valve: lessons to be learned in tricuspid regurgitation