A 34-year-old male with chest pain and shock was admitted as an emergency case to our unit. Ruptured acute aortic dissection with annuloaorticectasia was suspected and emergency operation was performed. Acute aortic dissection was localized at the aortic root. The right coronary orifice was involved with the dissection, and an intimal tear was found just above it. Aortic root replacement with composite graft was performed as follows. The aortic wall around the coronary orifice was incised in a circular manner like a button and the dissection of the aorta around the coronary orifice was repaired. Dacron tubes with xenopericardial skirts were interposed between the coronary orifices and the composite graft. Wrapping of the composite graft was completed using the aortic wall and xenopericardium. The postoperative course was uneventful with only slight bleeding. Our procedure is useful for acute aortic dissection around the coronary orifice.