Isolated tricuspid valve disease is rare in adults. It is seen in form of infection (endocarditis) in patients with abuse of i.v. drugs. Another rare cause of isolated tricuspid valve regurgitation is interference with the electrode of a permanently implanted electrophysiology device (pacemaker, defibrillator). Tricuspid valve regurgitation is seen frequently in mitral valve disease of long duration and is due to dilatation of the natural ring of the tricuspid valve. Surgical treatment is normally directed towards repair of the valve, either by implanting a specific prosthetic rigid ring or by bicuspidalization of the valve and / or by suturing the three leaflets in the middle (“trifoglio / trefoil”).