Type A aortic dissection occurs in 0.6% of patients late after aortic valve replacement. However, little information is available about risk factors for developing this complication, nor are recommendations for elective replacement of the ascending aorta available. The authors present a 78-year-old woman who developed type A aortic dissection thirty months after aortic valve replacement; ascending aorta was normal at the time of aortic valve replacement.