Description: A 72-year-old man received a non-emergent drug-eluting stent to mid-right coronary artery (RCA) for chest pain. He represented 3 weeks later with congestive cardiac failure and rigours. Blood cultures grew Streptococcus sanguinis (viridans); there was no history of rheumatic disease; however, a root canal abscess was treated 3 months prior. Transthoracic echocardiograms (TTE) revealed a thickened anterior mitral valve (MV) and posterior directed jet of mitral regurgitation as well as thickened, restricted posterior mitral valve leaflet (PMVL) with an insignificant gradient of 3 mm Hg. Transoesophageal echocardiogram (TOE) revealed a large 3.0×1.5 cm anterior MV vegetation causing functional mitral stenosis (MS) with a mean gradient of 10 mm Hg (figure 1). He went on to receive a mechanical MV replacement 5 days after diagnosis.