Mixed Tricuspid Stenosis and Regurgitation: Rheumatic involvement of the tricuspid valve is often seen in association with involvement of mitral and rarely aortic valve. Isolated rheumatic tricuspid valve disease is not seen. It usually produces tricuspid regurgitation with some amount of stenosis due to fibrosis and fusion of cornrnissures. Chordal thickening and fusion are usually mild and calcification is rarely seen. The other cause for combined stenosis and regurgitation is carcinoid syndrome. It mainly affects pulmonary and tricuspid valves (right sided cardiac valves). They will need tricuspid valve replacement with bio prosthesis. Valve cusps are thickened along with thickening and fusion of chordae. This produces a picture of mixed stenosis and regurgitation.