A 72-year-old patient was admitted to the Department of Cardiology of Emory University Hospital with the diagnosis of infective endocarditis. Two-dimensional transesophageal echocardiography (TEE) showed a vegetation attached to the posterior mitral valve leaflet that led to severe mitral regurgitation. Real-time 3-dimensional TEE clearly identified the large posterior leaflet vegetation but additionally showed the perforated posterior mitral valve leaflet. Real time 3D TEE, and especially the large sector-focused data, allow for detailed identification of the mitral valve leaflets from both the atrial and the ventricular side. Those characteristics of real-time 3D TEE confer incremental value in assessing infective endocarditis lesions and complications.