Intermittent chest pain with marked ST depression after 13 years of aortic valve replacement

An 80-year-old woman who underwent aortic valve replacement with a 19-mm Medtronic Hall prosthetic valve in 1993 was admitted because of intermittent chest pain. Electrocardiography on admission revealed non-specific changes, but electrocardiography during chest pain revealed significant ST depression. Coronary angiography revealed no significant stenosis. Echocardiography revealed intermittent severe aortic regurgitation and incomplete closure of the prosthetic valve in diastole. An urgent operation was performed, and abnormal pannus formation was observed at the left ventricular side of the prosthetic valve. In this case, intermittent diastolic valvular sticking caused severe aortic regurgitation and induced serious myocardial ischemia.