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In this article, we report the case of a 58-year-old man who was admitted to our institution with acute dyspnea and poor hemodynamic condition. He had undergone double mitral-aortic valve replacement five years earlier for rheumatic heart disease. Transthoracic echocardiography (TTE), cinefluoroscopy, and transesophageal echocardiography (TEE) revealed a significant reduction in the opening of the mechanical mitral valve leaflets. An urgent redo surgery was performed, during which the pannus was removed, ensuring the restoration of normal leaflet motion. This clinical case presents two rare circumstances: first, the unusual diaphragmatic pannus completely masking the mechanical mitral prosthetic valve, and second, the development of pannus at the level of the mitral mechanical prosthesis rather than the aortic mechanical prosthesis.