A 72-year-old woman from India underwent mitral valve replacement with a biological valve 2 years ago. Eight weeks later, she developed increasing dyspnea (New York Heart Association class II to III). A transesophageal echocardiogram (TEE) revealed recurrent mitral regurgitation and a paravalvular leak, which was suspected. The patient was referred for evaluation of transcatheter closure of a paravalvular mitral leak. A TEE study was performed (Videos 65-1 to 65-3 and Figs. 65-1, 65-2 and 65-3).