In clinical practice, we often encounter cases of tricuspid insufficiency after mitral valve replacement or bicuspid valve replacement. In fact, this is not a minority of patients, and a significant proportion of patients who have undergone mitral or bicuspid valve replacement will develop tricuspid insufficiency to varying degrees, even in some patients who have undergone tricuspid valvuloplasty. The management of this subset of patients with tricuspid insufficiency is controversial in medicine. Clinicians are not as aggressive in the management of this subset of patients, in large part because patients commonly choose conservative treatment when they come to the clinic and often have severe right heart insufficiency when they are intolerant and willing to have surgery, resulting in stasis of the body circulation and multiple organ insufficiency. At this point, the risk of surgery is significantly increased. From the cases we have encountered so far, the results of conservative treatment are not satisfactory in cases with severe tricuspid valve closure insufficiency. Although the course of right heart insufficiency is relatively long and progresses slowly, and clinical symptoms improve to a certain extent when diuretic treatment is given, this does not really improve the patient’s prognosis. As the disease progresses, the patient gradually develops clinical manifestations such as abdominal distension, hepatomegaly, and edema. Aggressive management of tricuspid valve insufficiency is beneficial to the patient, but not all patients with tricuspid valve insufficiency can be treated surgically with the expected outcome, and an important factor in this is pulmonary artery pressure. In patients with severe pulmonary hypertension, the clinical significance of dealing with tricuspid valve is not too great. Therefore, our experience is that right heart catheterization is required to assess pulmonary artery pressure and right ventricular function prior to surgical treatment. A typical case is that of a patient 19 years after bivalve replacement who underwent bivalve replacement and tricuspid valvuloplasty at a hospital in ’92. This year, right heart failure manifestations such as tricuspid valve closure insufficiency, ascites, bilateral lower extremity edema, chest tightness, anorexia, hepatomegaly, and jaundice were found. After admission, he was given dobutamine cardiopulmonary therapy, which resulted in a significant increase in urine output, weight loss, and improvement in clinical symptoms, but the symptoms began to worsen as soon as dobutamine was discontinued. Finally, we performed tricuspid valve replacement surgery on him, and after replacing the tricuspid valve, the patient’s symptoms improved significantly and his quality of life improved significantly.