We report on a case of a rare tumor attached to the nodulus arantii of the left coronary cusp in a 56-year-old female patient. She was referred to our institution for a non-ST elevation myocardial infarction after a troponin-positive test. Diagnosis was made by echocardiography and confirmed by surgery. After complete surgical removal of the tumor, we reconstructed the left coronary cusp with autologous pericardium. Aortic valve cusp coaptation could be completely restored. Histology revealed the diagnosis of a papillary fibroelastoma.