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Prosthetic valve obstruction has an incidence ranging from 0.4% to 6% per year (1). Apart from thrombus formation, prosthetic valve obstruction can also be caused by pannus formation with variable frequency (2, 3). Correct diagnosis is of paramount importance in any patient with prosthetic valve obstruction. Real time three-dimensional echocardiography (RT 3D TEE) has the capacity to provide more in-depth analysis of any pannus related mechanical valve obstruction.