ptlawrence I imagine that would fail without the aws translation in place.
Yep that would definitely fail.
Unfortunately, I don’t know how the AWS NAT64 translation works, but I can imagine that it isn’t suitable for running a mail server. Your server needs a dedicated public IPv4 address with a corresponding reverse DNS (PTR) record in order to be able to exchange email with other mail servers over IPv4. Otherwise, the receiving server would most likely reject your emails, or at least classify them as spam.
You could of course use an external mail relay service, or maybe Amazon itself offers a solution, but I doubt that such a solution would be cheaper than simply adding an IPv4 address to your AWS instance. As I said, I’m not familiar with AWS, but Hetzner, for example, charges only 0.00086 €/h for an IPv4 address.