about 30 y old patient with condition after implantation of bioprosthesis in mitral-valve- and aortic-valve-position in africa (NO documents available; indication isn´t known: mitral-valve- and aortic stenosis caused by rheumatic fever?? The patient told that the cardiac valves were very stiff.). The patient was admitted to our ER with recurrent subfebrile fever and dyspnoea, In TTE we found a very interesting result: the mitral-valve bioprosthesis seemed to be downwards tilted into the LVOT with obstruction of LVOT (PG mean 45 mmHg!!). The aortic valve was presented tenuous without pathological gradient but a little bit to small in its diameter.