Fifty patients with rheumatic multivalvular disease underwent a modified form of semicircular tricuspid annuloplasty for acquired tricuspid insufficiency along with mitral or mitral and aortic valve procedures. The modification allowed simulataneous tying of annuloplasty sutures and digital assessment of the tricuspid regurgitation on unsupported normothermic beating heart. Early postoperative assessment showed 8 (17.3%) patients with no regurgitation, 36 (78.2%) with trivials to mild regurgitation and 2 (4.3%) with moderate regurgitation. There were 4 (8%) early deaths not related to the tricuspid lesion. Over a follow-up period of 6–84 (mean 38) months with around 70 per cent compliance, only three patients showed progression of tricuspid regurgitation. In all other patients the tricuspid regurgitation remained controlled. The study suggests that the modified annuloplasty technique used is an efficient way to achieve predictable annuloplasty results.