A 78 year old man underwent aortic valve replacement because of acute aortic regurgitation and intractable heart failure. At operation the intact commissure between the left and right coronary cusps of a grossly normal aortic valve was found to have separated from the aortic wall. Histopathological examination of the surgical specimen showed that the site of separation was an atheromatous plaque. This is believed to be the first report of this feature.
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