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To date, the incidence of penetrating aortic ulcers is from 2 to 7 % of all cases of acute aortic syndrome, localization of this pathology in the ascending aorta are casuistic. We present the case of an intraoperative finding of a penetrating ulcer of the ascending aorta. The patient underwent separate prosthetics of the ascending aorta with the vascular prosthesis Uni-Graft No. 28 and the aortic valve prosthesis with the mechanical prosthesis Medtronic No. 23. The patient was discharged on the 8th day in a satisfactory condition. Penetrating atherosclerotic ulcer is a potentially life-threatening condition, the detection of which requires aggressive tactics of surgical treatment.