We report the case of a 57-year old man who was admitted to our department because of worsening dyspnea - orthopnea and whose aortic valve had been replaced 31 years previously, with a Starr-Edwards caged-ball prosthesis. His symptoms' deterioration was due to a recent myocardial infarction which in combination with the chronic mitral regurgitation of rheumatic origin led to heart failure. As assessed by echocardiography the mechanical prosthesis did not show signs of significant dysfunction and except for mild regurgitation, it had a good performance. Despite some valve related complications, such as the recurrent thromboembolic events that our patient had, his Starr Edwards aortic prosthesis demonstrated an excellent long term durability and reliability.