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A 24-year-old man presented with late stenosis of a cloth-covered Starr-Edwards valve (model 2320). Fibrous ingrowth occurred at the inflow orifice of the valve and all three struts were adherent to the aortic wall, creating a "tunnel" form of obstruction. The stenotic valve was replaced with a porcine heterograft, and the small aortic root was enlarged with a Dacron patch. This form of late prosthetic valve stenosis should have been prevented by enlargement of the aortic root at the time of valve insertion and by long-term anticoagulant therapy.
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