Abstract
Aortic stenosis with a small annulus recently has been more frequently managed with the posterior annular enlargement technique. However, the risk of a short valve-to-coronary distance of the right coronary artery may remain in patients with small sinus of Valsalva. This report presents the case of a patient with severe bicuspid aortic stenosis with a small annulus and a small sinus of Valsalva who was treated with the "Y and I" incision technique, including posterior annular enlargement using the Y-incision technique and anterior extended aortoplasty.