The treatment of functional tricuspid insufficiency associated with rheumatic left sided valvular lesions continues to challenge surgeons throughout the world. Opinions vary as to how tricuspid insufficiency should by treated. The present choices are:1.To expect spontaneous regression after correction of left sided valvular lesions. 2.To replace tricuspid valve. Mechanical prosthesis is associated with high incidence of thromboembolism in tricuspid position while biological prosthesis is associated with rapid structural valve degeneration especially in young patients. 3.To repair tricuspid valve. Three methods are described for tricuspid valve repair. (1)Bicuspidization annuloplasty: changing tricuspid valve from trileaflet valve to bileaflet one. (2)Ring annuloplasty: is a good alternative but is associated with economic burden as these rings are very expensive & whether they have any advantages over semicircular annuloplasty is doubtful. (3)Semicircular annuloplasty: the most commonly used semicircular annuloplasty techniques are DeVega annuloplasty and segmental annuloplasty. This study compares the results of bicuspidization and segmental annuloplasty in the management of functional tricuspid insufficiency. The operations were done in 50 patients and included simultaneous correction of rheumatic left sided valvular lesions. Each operation was performed in 25 patients. Re-evaluation of these patients showed that both annuloplasty techniques gave comparable and good results in early postoperative period, as well as on follow up until six months postoperatively. Also both are simple, rapid, provide pliable annulus, eliminates the insertion of foreign material and free from the risk of producing atrioventricular block.