Cardiac papillary fibroelastomas are rare and have been considered a "benign," incidental finding. With two-dimensional echocardiography, these tumors can now be readily diagnosed. A young male patient who had a stroke due to a mitral valve papillary fibroelastoma is described. In this patient, not only did preoperative echocardiography establish the diagnosis, but intraoperative transesophageal two-dimensional echocardiography was utilized to guide tumor excision.