UNLABELLED: The anomalous origin of the left circumflex artery (LCx) from the right coronary sinus is one of the most common coronary anomalies. However, it presents a significant technical challenge during aortic root surgery. This case report describes a patient with a bicuspid aortic valve, anomalous circumflex artery origin, severe aortic stenosis and moderate aortic regurgitation, and aneurysms in the ascending aorta and aortic root. We addressed this through the Bentall procedure, utilizing the combined coronary button technique for a safe and successful management approach. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-024-01808-4.