Elevated transaortic valvular gradients following double valve replacement (DVR) both aortic and mitral, can be secondary to the following conditions: left ventricular outflow tract obstruction (LVOTO) by prosthetic mitral valve strut encroachment or residual native mitral valve apparatus, prosthesis dysfunction, prosthesis–patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients in patients with significant left ventricular hypertrophy and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Use of comprehensive intraoperative transesophageal echocardiography is thus imperative fortimely diagnosis and prompt intervention.We present a case of partial LVOT obstruction from mitral valve prosthesis after DVR leading to a high transaortic valve gradient. Intraoperative 2D transoesophageal echocardiographic examination revealed encroachment of the left ventricular outflow tract by the prosthetic mitral valve (31 Magna) strut in the mid esophageal long axis view. Colour flow in the same view showed unusual turbulence of flow across the aortic valve and proximal ascending aorta. Application ofcontinuous wave Doppler(CWD) showed a peak gradient of31 mm Hg and mean gradient of 15 mm Hg across the Carpentier Edwards Perimount 21 aortic prosthesis (peak gradient 25.69±9.9 mm Hg). Reconstruction of the LVOTin our case using 3-Dimensional echocardiography then showed lack of any significant LVOT encroachment by the strut. This case establishes the superiority of 3D echocardiography in the assessmentof prosthetic heart valves and highlights the role of comprehensive 2D and 3D intraoperative TEE in avoiding any unwarranted surgeries.