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Background: Tricuspid annuloplasty ring sizing is based on the depth of the anterior tricuspid valve (TV) leaflet. In dilated right hearts the TV annulus dilates septo-laterally, making this measure unreliable. We assessed whether the septal tricuspid leaflet is more consistent in right heart dilatation and provides a better assessment of TV ring size.Methods: 20 patients were studied: normal controls (n=10), and dilated right hearts (DRH, n=10). 3D zoom images were acquired of the TV using x72t transducer and iE33 imaging platform (Phillips). Using commercially available software (3DQ and MVQ, Phillips) we measured the length of the septal tricuspid leaflet in end-systole and other TV annular parameters including: circumference, area, antero-posterior diameter and septo-lateral diameter.Results: See table. All parameters of the TV annulus were significantly larger in the TR patients except the septal leaflet length.Conclusions: Septal leaflet length varies minimally with right heart dilatation, making it ideal for sizing tricuspid valve annuloplasty rings.