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Mechanical valve thrombosis is a rare but serious complication that requires rapid diagnosis and treatment. In most reported cases, inadequate anticoagulation or cessation of anticoagulation is the cause of the prosthesis thrombosis. We present a clinical case of a patient who underwent aortic valve replacement with a mechanical valve St. Jude Medical 10 years ago. Due to several sudden collapses and absence of the metallic click sound the patient was transported to our hospital. The patient was admitted in the cardiology department in severe general condition. We performed transthoracic echocardiography, transesophageal echocardiography, fluoroscopy and we established a dysfunction of mechanical aortic valve. Surgical treatment was undertaken: the dysfunctional aortic valve was removed and the new LivaNova Crown biological valve was implanted. The macroscopic surgical finding, a thrombosis in mechanical aortic valve, and the histology result proved the pattern of mixed thrombus. After the procedure patient presented with third-degree atrioventricular block which required the implantation of a permanent pacemaker St. Jude Medical, DDD mode. The patient was discharged on the tenth postoperative day in a good general condition. Although thrombosis of mechanical aortic valve prosthesis is a rare complication and most common in first year after implantation, all patients require lifelong follow-up by a cardiologist. [ABSTRACT FROM AUTHOR]