Tricuspid valvuloplasty is indicated in patients with recalcitrant tricuspid valve insufficiency. Expansion of the tricuspid annulus is limited to the anterior and posterior annuli, whereas the septal annulus is constant and this part does not dilate even in severe insufficiency of closure. (i) The DeVega procedure is indicated in cases of generalized annular dilatation. Using a 4-0 double-ended atraumatic stitch with a small spacer, a continuous mattress suture is placed on the anterior annulus between the posterior-septal and anterior-septal junctions, starting with the annulus near the posterior-septal junction and following the annulus counterclockwise straight to near the anterior-septal junction. Each stitch is sutured to the endocardium and annulus, with each stitch spaced approximately 5 to 6 mm wide. while the sutures around the atrioventricular annulus are drawn tightly, the operator places two fingers or a plug gauge inside the valve orifice as a standard for annular reduction. In adults, the tricuspid annulus is generally reduced to an orifice area of about 3 cm2 or can be passed through more than two fingers of the operator without stenosis. (b) Kays surgery Some cases are limited to the posterior leaflet attachment portion of the annulus that is significantly dilated, resulting in partial closure insufficiency, and such patients can undergo Kays surgery. A 4-0 noninvasive suture is used to make an “8” suture on the annulus of the posterior lobe, i.e., the junction between the anterior and posterior lobes is sutured first, followed by the junction between the posterior and septal lobes. After the “8” suture is knotted, the posterior lobe is eliminated, so that the remaining septal lobe and anterior lobe are adequately aligned, thus eliminating regurgitation. (iii) Artificial annulus grafting If the annulus is too much shrunken, the leaflets will be wrinkled and their function will be affected. The reduction of the annulus with an artificial annulus can maintain the integrity of the anterior and posterior leaflets of the tricuspid valve and avoid the disadvantages of leaflet wrinkling due to suture reduction of the atrioventricular annulus, which affects the function of the leaflets and makes the surgical effect less durable. The full length of the septal annulus is measured with a gauge and used as a criterion for selecting the prosthetic annulus. To avoid compression of the AV node and its end branches after transplantation, the straight chord of the annulus is interrupted to leave a gap. The septal-anterior and posterior-septal junctional gaps, especially the posterior annulus, are shortened after the prosthetic annulus is transplanted, so that the trilobular valves can be fully aligned after surgery. After the operation, the heart is resuscitated and the closure of the valve leaflets is viewed through the right atrial incision under conditions of a beating heart and a blood-filled right heart. This method of observing leaflet closure under direct vision is more accurate than injecting saline under pressure into the right ventricular cavity.