Your heart is undergoing a lot of changes. No answers necessarily, but here are some thoughts from a non-medical-professional viewpoint...
With the high-pressure system you had, the pressures themselves can seal up some leakage, such as the tricuspid. Letting off the pressure can cause some leakages as well. There is a fair likelihood that there wasn't a tricuspid leak when you were "at pressure."
- Trace leakage is often temporary and isn't really actionable, even if you're working close by, in the next ventricle. It's so little that it comes and goes for many people from echo to echo, and it can often be changed if the petient shifts angles during the echo. The surgeon likely wouldn't be able to tell if yours would stay a slow drip as it was, or turn into an unfortunate faucet that's always running. I am a bit surprised he did nothing with the aortic valve while he was there, though.
- Most people who have mitral work done don't require any attention to their tricuspid valves, so with a lack of more than trace regurgitation, there would be little impetus for the surgeon to fix something that probably didn't appear to be broken.
- Your heart was likely enlarged, and is now beginning to remodel (return approximately to its original size). That process often happens somewhat unevenly, and causes some misalignment of valves and their seatings. While it wouldn't be entirely responsible for a moderate regurgitation, it can contribute. Transient trivial and mild regurgitations from this come and go during recoveries.
- Your entire system has been running with extraordinarily high pressure for some time. The semi-separate pulmonary (lungs) circuit may still be at high pressure (it's common for people with valve issues to have secondary pulmonary hypertension, even if they don't have high BP). That often recedes after successful valve surgery, but not always. Sometimes it can't ramp down and evolves into Primary Pulmonary Hypertension. It takes a while, so it's a wait-and-see game.
- You might ask if there's some enlargement of your right ventricle, as that might go along with the tricuspid leak and the high pulmonary pressures. Other things that might accompany it are enlarged atria, the left from pressure from the lung circuit, the right from backpressure from the tricuspid leakage. However, it might not be easy to tell if it's from this issue or your previous issues. An enlarged right atrium can make a tricuspid valve seat poorly. If there's PH, there's also backpressure against the tricuspid valve when the right ventricle is trying to fill the pulmonary artery.
- Your heart is now pumping much less hard than it was before. It may take a while for it to find its proper beat strength. Your Ejection Fraction may come and go a bit for a while. And the Aortic Regurgitation affects the EF negatively as well. If you are on a beta blocker, they might want to cut it down or change it over to a different prescription, like an ACE inhibitor or a calcium channel blocker that won't soften the beat.
- valves that are exposed to high pressure and are then used at lower pressure have a tendency to be or to become somewhat leaky. For this reason, aortic donor homografts are no longer used as pulmonary grafts. Oddly, it doesn't seem to be a problem the other way around.
Time will likely improve some of your problems, but not all. Echoes are not really accurate for pulmonary pressures, so you can take that with a grain of - um - non-sodium salt substitute. An MRA might show you something, or even an echo from a different tech. A stress test probably will not show much that's helpful at this point.
Best wishes,
