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In this paper, we described a case of thrombosed Hall-Kaster valve who suffered from recurrent coronary thromboemboli.The patient was a 39 year-old man who received an operation of aortic valve replacement (Hall-Kaster valve) and mitral valve replacement (St. Jude Medical valve) for his rheumatic heart disease 10 years ago (Fig. 1). Since then he had been chronically anticoagulated using warfarin and remained symptom free. He suffered from acute myocardial infarction on January, 1989 and unstable angina on April, 1989. Coronary angiogram at the time of those two episodes revealed thrombi in left coronary artery system (middle portion of left anterior descending artery, left main trunk) (Fig. 4, 5, respectively). Although we suspected of thrombosed prosthetic valve, the diagnosis could not be made by auscultation, echocardiogram including Doppler technique, cardiac catheterization and angiogram before the operation. Patient's blood sample revealed high level of D-dimer at the time when the coronary artery thrombi disappeared on angiogram. It was speculated that thrombus derived from elsewhere (Table). On November 21, 1989 he suffered from acute left-sided heart failure due to thrombosed valve with chest pain. Although emergency re-operation of valve replacement was carried out, he died during the operation. The inspection at the time of the operation revealed thrombosed Hall-Kaster prosthetic valve (Fig. 6).

Recurrent Coronary Thromboembolism Secondary to Thrombosed Hall-Kaster Prosthetic Heart Valve Documented by Coronary Angiogram