An Angell-Shiley heterograft valve was implanted in a 32-year-old woman with severe aortic regurgitation and stenosis. Post-operatively acute bacterial endocarditis occurred, due to group C streptococci. Because of severe acute aortic insufficiency with partial dehiscence of the heterograft valve and increasing left heart failure re-operation was necessary. After successful replacement of the valve an aortocoronary bypass was connected to the left circumflex artery because of displacement of the left coronary ostium. In addition, an aortoplasty was performed for spontaneous aortic rupture. Because of severe left heart failure with myocardial infarction in the course of the operation circulatory support with a paracorporeal artificial heart was necessary for 60 hours postoperatively. Despite transitory improvement the patient died from septic shock 30 days after the re-operation.