The evaluation and management of tricuspid regurgitation (TR) are often challenging. Significant TR is an independent predictor of reduced event-free and overall survival. Therefore, an evidence-based approach to the diagnosis and treatment of TR is of critical importance. TR can be classified into two basic categories: primary and secondary TR. The former refers to conditions in which the primary pathophysiologic process affects the valve itself, whereas the latter is much more common and occurs due to tricuspid annular dilatation, right heart failure, and/or pulmonary hypertension. Two- and three-dimensional echocardiography allow for a comprehensive assessment of TR severity and mechanisms. In patients with fixed pulmonary hypertension and right ventricular dysfunction, medical management of TR is generally preferable. In patients undergoing mitral valve surgery, tricuspid annular dilatation should trigger prophylactic tricuspid valve repair, regardless of the degree of TR. Future efforts in TR management will include development of percutaneous repair procedures.