A 62-year-old man underwent mitral valve replacement with a Starr-Edwards caged-ball prosthesis in 1974. He was asymptomatic until February 2005 when he underwent a new cardiac evaluation because of increasing dyspnea and peripheral edema. The echocardiogram showed a severe aortic regurgitation and a mitral valve prosthesis well functioning. At reoperation, the mitral prosthesis and the aortic valve were replaced with St. Jude Medical((R)) bileaflet mechanical prostheses. At macroscopic and radiographic inspection the Starr-Edwards was free from signs of structural valve degeneration. This case demonstrates the impressive durability of a Starr-Edwards prosthesis in mitral position.