Today, 3-dimensional transesophageal echocardiography (3D TEE) represents a novel technique for the assessment of significant paravalvular prosthetic reflux. This test allows us to improve the spatial location of the cardiac pathology in question. Major prosthetic paravalvular regurgitation may result in the development of symptoms of heart failure and hemolytic anemia, with an incidence of up to 1% to 5% in all cases.1,2 Up to 60% of prosthetic leaks occur during the first year after valve replacement,1,2 and an estimated 10% of prosthetic aortic valves and 15% of prosthetic mitral valves show a nonsignificant degree of paravalvular regurgitation.2 Kronzon et al3 compared in 18 patients with dehiscence of mitral valvular prosthetic ring the use of 2-dimensional TEE and 3D TEE and concluded that, unlike the 2-dimensional ultrasound, 3D ultrasound can identify the exact size, shape, and area of the affected segment.1,4,5 The 2-dimensional technique still has a role in the initial assessment, which allows us to suspect that there might be an anomaly by the existence of a significant paravalvular reflux in the presence of a prosthetic dehiscence. However, there is a greater possibility that the 2-dimensional techniques underestimate the size of the defect, mistake its location, and even suggest the presence of defects not subsequently observed during surgery.1 In line with previous authors,6 we describe the following case in which 3D TEE was both a complementary and a …