Persistent tricuspid regurgitation (TR) caused by infarction or ischemia of right ventricle (RV) is rare and has not been reported by coronary vasospasm previously. We reported the two cases of patients with persistent right heart failure (HF) and severe TR by coronary vasospasm. After RV infarction or ischemia, two-dimensional (2D) echocardiographic examination revealed normal left ventricular function, but RV hypokinesia, RV and tricuspid annular dilation, and severe TR with normal appearance of tricuspid valve itself. Subsequent coronary angiography and cardiac catheterization revealed coronary vasospasm without significant coronary artery stenosis and pulmonary hypertension. Repeated echocardiography showed persistent right HF and severe TR at 5 years and 4 months later in respective cases. In conclusion, we suggest that RV infarction or ischemia with coronary vasospasm can be one of the causes for isolated TR and tricuspid annular dilation.