Hello , More and exact information about the status of mitral repair and the right heart will be available as we get a 2 D echocardiography done . The cause of the same depends on the reason why mitral valve repair was done . Generally the possibilities are 1) Higher lung pressure causing right valve leak , dilatation or decreased pumping 2) The repair has lived its time as its 7 years , and the disease might have progressed 3) Any new mitral disease 4) In previous era , tricuspid valve was not repaired even if it had moderate to severe disease considering its self healed after mitral repair. So the same may have progressed 5) Fall in function of left beart post mitral repair . There can be hundred assumption, an 2 d echo and examination by your cardiologist would help get to exact diagnosis. The treatment for the same is based on etiology . Regards Dr. Mody