Functional tricuspid regurgitation is a direct outcome of right ventricular dilatation and tricuspid annulus dilatation. The mechanism underlying functional tricuspid regurgitation is believed to be multifactorial and related to abnormalities in right ventricular volume, function and shape. Changes in the right ventricle geometry may lead to alterations in the positions of the papillary muscles (PM) of the tricuspid valve (TV). PM displacement happens in right ventricular dilatation but its correlation with tricuspid annulus dilatation is still unknown. The unique structure and orientation of tricuspid PM has role to play in TV annulus mechanics and right ventricular mechanics (Fig.1). It has been already shown that annulus tension (AT) is a parameter to evaluate left ventricular function that, previously, was evaluated via the left ventricular geometry and pressure [1–3].

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