A 27-year-old man was referred to our hospital for rightsided heart failure. At the age of 19 years, he had undergone tricuspid valve replacement (TVR) with a bioprosthesis, a Carpentier–Edwards pericardial (CEP) valve, because of infective endocarditis of the tricuspid valve (TV). On examination, he was afebrile, with a blood pressure of 110/66 mmHg and a heart rate of 84 bpm. Auscultation of the heart was notable for a grade 3/6 holosystolic regurgitant murmur and diastolic murmur at the 4th left sternal border. Jugular venous distention and peripheral edema were observed. Dilatation of the right atrium was observed in transthoracic echocardiography and a tricuspid regurgitation (TR) jet was seen on a color Doppler image. Continuouswave Doppler showed a mean pressure gradient of about 12 mmHg across the bioprosthetic TV. Real-time threedimensional transesophageal echocardiography (RT3DTEE) (iE33; Philips, Bothell, WA, USA) was performed in order to evaluate the prosthetic valve function. The RT3DTEE demonstrated tricuspid stenosis with restricted leaflet motion, incomplete closing bioprosthetic TV, and obvious TR (Figs. 1 and 2). The leaflets are thickened and fibrocalcific, with decreased mobility. A redo TVR was performed for valve dysfunction of the CEP. The causes of bioprosthetic valve dysfunction in this case were concluded to be fibrotic and sclerotic degeneration with calcification based on the pathological findings of the extracted bioprosthesis. The RT3D-TEE findings were consistent with these pathological findings.