about 70 y old patient with prolonged weakness and subfebrile fever. The markers of inflammation were high. Condition after mitral valve replacement (bioprosthesis) and permanent atrial fibrillation is known. In TTE we saw a thickening of mitral valve bioprosthesis. In TEE I could demonstrate a severe endocarditis of mitral valve bioprosthesis without insufficiency but severe mitral stenosis because of thickening and decrease of valve motion of mitral bioprosthesis (PGmean about 12-15 mmHg). By the way, look at the LAA: you can see a beginning thrombus in there despite of therapeutical anticoagulation with UFH (aPTT about 60 - 80 sec).