A 60-year-old man with a history of endocarditis presented with congestive heart failure New York Heart Association class III symptoms. He did not have any signs or symptoms of microembolic phenomenon and the blood cultures were negative. A transesophageal echocardiogram showed an eccentric jet of mitral regurgitation (MR) from a perforation in the anterior mitral valve leaflet (MVL) (Fig. 1, Video 1). There were no visible vegetations however; there was an eccentric jet of aortic insufficiency (AI) pointing directly against the point of anterior MVL perforation (Fig. 2, Video 2). Thus the primary lesion was AI from previous endocarditis with secondary involvement of the MV. The patient underwent mechanical mitral and aortic valve replacement. Intra-operative cultures of valve tissue were also negative and the pathology was consistent with fibrosis.