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"Ball valve thrombus" which is a spherical free-floating clot in left atrium is an often quoted, but uncommonly encountered complication in patients with severe mitral stenosis of rheumatic origin, who are in atrial fibrillation. We describe the case of a 48-year-old man with rheumatic heart disease, severe mitral stenosis, and severe aortic regurgitation. The patient presented with an episode of non-exertional syncope resulting in CVA 1 month back and breathlessness on exertion of 6 months duration and was in normal sinus rhythm. Echocardiography facilitated ante-mortem diagnosis and prompt institution of surgery was lifesaving.