This case report describes the diagnostic and treatment challenges of the combined disc impediment caused by pannus ingrowth in combination with thrombus formation in a 21-mm Medtronic-Hall aortic valve prosthesis. A combined obstruction of a Medtronic-Hall prosthesis in the aortic position is a rare, but potentially fatal clinical condition for the first time reported in Vilnius University Hospital Santariškių Klinikos. Despite the difficulties in determining a correct diagnosis, our critically ill patient was clinically stabilized by partially successful thrombolysis and then successfully treated by a surgical thrombectomy together with pannus excision during the rotation of the disc within the valve housing 3 years after the valve implantation.