Colen T, et al. - Researchers here aimed to examine changes in tricuspid valve (TV) function in hypoplastic left heart syndrome (HLHS) between the first two stages of surgical palliation. In addition, they ascertained the mechanism of tricuspid regurgitation (TR) at the time of stage two surgery—bidirectional cavopulmonary anastomosis (BCPA). To interstage stressors (increased preload and afterload), the TV in HLHS adapted by increasing leaflet size to maintain adequate leaflet coaptation. They observed greater leaflet size and prolapse in association with significant TR at prior to BCPA. Findings thereby suggested TV maladaptation from an excessive response in leaflet expansion to stressors.