Aortic valve papillary fibroelastomas are rare benign tumours which may present with the sequele of embolisation, coronary occlusion or sudden death. We report a case of a 68 year old lady presenting with unstable angina who appeared at coronary angiography to have thrombus in the right coronary ostium. Increasing right territory ischaemia prompted echocardiography, which diagnosed a mass in the right coronary ostium. Urgent surgery was undertaken, demonstrating chronic impaction of an aortic valve fibroelastoma in the right coronary ostium. Aortic valve replacement and coronary bypass grafting to the distal right coronary artery (RCA) was performed. This case illustrates a common cardiology presentation caused by the complication of a rare tumour.