Abstract
A 38 year old salesman with rheumatic heart disease had his mitral valve replaced with a Starr-Edwards valve prosthesis in 1963 and his aortic valve replaced with a Hufnagel valve prosthesis in 1968. After the second procedure, he experienced the following complications: hemiparesis, hemolytic anemia, aortic insufficiency, and profound heart failure. What are the diagnostic considerations?