central regurgitant jet and holodiastolic flow reversal in the pulmonary arteries. The patient underwent a tricuspid repair with a 30mm tricuspid ring and pulmonic valve replacement with a 25 mm bovine valve on POD 10. Surgical endomyocardial biopsy had no evidence of rejection. His heart failure symptoms resolved and he was discharged 4 weeks post op. Summary: We describe a novel case of a 39 yo orthotopic heart transplant recipient with acute post operative concomitant TR and PI with right heart failure requiring a tricuspid ring annuloplasty and pulmonic valve replacement. To date, there are no such reported complications after heart transplant. The incidence of isolated tricuspid valve regurgitation after heart transplant have decreased with the bicaval transplantation technique however not eliminated. Literature suggests that isolated moderate to severe tricuspid valve regurgitation should under a repair or replacement early post transplantation. Pulmonic valve insufficiency is extremely rare after heart transplant and management strategies are not well defined.