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We report an interesting but rare 2D ECHO image of a ‘ball and cage’ prosthetic mitral valve resembling a ’starry sky’ pattern, possibly secondary to degeneration of the silicon rubber ball. In addition, a unique rotatory axial motion of the ball was noted explained probably by hemodynamics based on Bernoulli’s principle. There is no conclusive evidence to support whether they represent a normal finding or an abnormal hemodynamic or structural pathology.