Rheumatic heart disease affects the tricuspid valve in about 30-50% of cases causing shortening of the chordae or fusion of the commissures resulting to tricuspid insifficiency, tricuspid stenosis or a combination of both. Aside from causing organic disease of the tricuspid valve, rheumatic involvement of the aortic and/or mitral valves eventually lead to pulmonary hypertension, dilatation of the right ventricle and right ventricular annulus resulting to functional or secondary tricuspid insufficiency.
Management of tricuspid valve disease in association with significant aortic and/or mitral valve lesions has been a subject of controversy. In the early years of valvular surgery, conservative management , that is, leaving the tricuspid valve alone has been advocated since multiple valve surgery is beset by a high operative mortality. It was however found out that correction of the associated tricuspid valve pathology added to the improvement in cardiac performance, that postoperative course has been smoother in repaired or replaced tricuspid valve and that reoperation for residual tricuspid insufficiency after left-sided valve replacement has carried a high operative mortality.
The question of whether to replace or repair the tricuspid valve and whether or not to use a ring to repair the tricuspid annulus has been addressed to in previous studies. The accepted practice now is to do surgery in significant tricuspid valve lesions simultaneously with the left-sided valves with preservation of the tricuspid valve apparatus as much as possible. The placement of a ring for selective remodelling of the tricuspid valve annulus has been advocated.