A retrospective study of 27 cases compared the long term clinical and echocardiographic results of tricuspid valve annuloplasty by the Bex (15 patients) and the De Vega (12 patients) techniques. All patients were in NYHA Classes III or IV before surgery. There was associated mitral valve disease in 24 cases and mixed mitral and aortic valve disease in 3 patients requiring valve replacement. The follow-up period ranged from 3 to 106 months (average 48 +/- 4 months). All patients underwent clinical and color Doppler echocardiographic evaluation. There was symptomatic improvement after surgery as all patients recovered to NYHA Classes I or II. An echocardiographic classification was adopted to assess residual tricuspid regurgitation. The leak was judged to be significant when the surface area of the jet was greater than 5 cm2. Two thirds of patients (17/27) had no significant residual tricuspid regurgitation with the Bex or de Vega techniques of tricuspid annuloplasty according to this criterion. However, significant residual tricuspid regurgitation was observed in 37% of patients (10/27) even though they were all clinically improved. A comparison of the echocardiographic parameters including the severity of residual tricuspid regurgitation, the left and right atrial dimensions, the right ventricular dimensions and tricuspid valve pressure gradients did not show any significant long term difference between the Bex and the De Vega tricuspid annuloplasties.