BACKGROUND: Adequate exposure of a ventricular septal defect (VSD) is critically important to obtaining a satisfactory repair. Some surgeons have advocated a circumferential incision on the tricuspid valve. For 20 years we have used a radial incision of the tricuspid valve when added exposure is required. METHODS: All patients undergoing VSD repair at Children's Memorial Hospital (Chicago, IL) were identified from our database. Operative records were reviewed to determine details of exposure. Follow-up patient and echocardiography data were obtained from the medical record. RESULTS: Between January 1995 and March 2010, 366 isolated VSDs were repaired, including 341 perimembranous, 15 muscular, 5 inlet, and 5 inlet-muscular VSDs. A radial tricuspid valve incision was used in 230 patients (63%). Mean times (minutes) were 97+/-24 for cardiopulmonary bypass and 66+/-18 for cross-clamp, with no significant difference between groups (p=0.59 and p=0.96, respectively). No operative deaths occurred. Follow-up echocardiograms were available for 150 patients at a mean of 3.5 years. Tricuspid regurgitation was rated as none or trivial in 97 (65%), mild in 45 (30%), and moderate in 8 (5%). The degree of tricuspid regurgitation was similar between patients whose tricuspid valve was and was not incised. CONCLUSIONS: Radial incision of the tricuspid valve enhances exposure for safe VSD closure and adds little complexity to the case. Its use in our series did not lead to increased tricuspid valve dysfunction, and it was durable at midterm echocardiographic assessment.