A bicuspid aortic valve sometimes coincides with a sinus of Valsalva aneurysm having a coronary artery anomaly. A meticulous aortic root replacement strategy is needed in these cases. In a 64-year-old man, the left coronary arteries (LCA) with an aberrant origin were excised together and reattached to the side hole of a valved conduit via a short Dacron graft. To prevent the formation of an aneurysm at the site, a strip of Dacron graft was sutured from outside between the LCA. The procedure for aortic root replacement with a coronary anomaly needs a case-by-case surgical strategy.
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