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The factors influencing the occurrence of functional tricuspid regurgitation (TR) are less studied. Current ESC guidelines recommend performing the echocardiographic measurement of TV annulus before cardiac surgery but there is no recommendation for tethering evaluation or for the choice of a specific surgical technique. The aim of this study was to evaluate correlation of echocardiographic assessment of TV tenting area and coaptation depth and TR severity as well as tricuspid annulus dimension in patients with functional TR before surgery and assessment of changes in these parameters in patients with severe functional TR after complex TV repair.Methods: 54 patients (65.25 ±17.15 years; 21 women) with functional TR of different degrees were prospectively enrolled and underwent TV repair. All patients underwent 2D TTE before and after cardiac surgery. The following parameters were evaluated: the severity of TR, the tricuspid annulus dimension, the presence of tethering, the tenting area and coaptation depth. TR severity was assessed via color Doppler flow mapping. Measurements were:TV annulus diameter in A4C-the distance between points of reflection of septal and mural endocardium on anterior and septal tricuspid leaflets, tenting area by tracing the leaflets atrial surface and tricuspid annular plane at maximal systolic closure time,coaptation depth from the annulus plane to the leaflets coaptation point. SPSS was used for statistics.Results: TR had a moderate positive correlation between TR severity and both tenting area (r=0.46, p<0.001) and coaptation depth (r=0.44, p<0.001). Tricuspid annulus dimension had a moderate correlation with tenting area (r=0.4, p=0.002) and coaptation depth (r=0.32, p=0.017). 14 patients with severe TR underwent TV repair by extension of anterior leaflet associated with annuloplasty. The percentage of tricuspid valve tethering in patients with severe TR decreased from 25.5% to 5.45% (p<0.001). The postoperatory coaptation zone parameters significantly reduced compared with preoperatory data (tenting area from 2.13 ±0.15, 95% CI [1.82-2.43] to 1.15±0.06, 95% CI [1.04-1.27] and depth coaptation from 8.7 ±0.49, 95% CI [7.72-9.69] to 6.89±0.3, 95% CI [6.29-7.49].Conclusions: TR correlates with TV remodeling in functional TR. In patients with severe TR the preoperatory echocardiographic evaluation should include besides the measurement of tricuspid annulus dimension, the assessment of the leaflet tenting area and coaptation depth. Complex TV repair reduces the tethering of the TV and it should be the technique of choice in patients with severe functional TR.