The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered.1 Although encouraging results have been reported concing simultaneous pulmonary tumor resection, carotid endarterectomy or abdominal aneurysm repair,2-5 detailed knowledge concing further coexisting non-cardiac diseases requiring surgical therapy is still lacking. In some extremely rare cases patients suffer from more than just one coexisting disease of different origins: the current report focuses on a 61-year-old female patient suffering from ischemic heart disease, occlusion of the innominate artery and a retrostal goiter as an incidental finding. She was treated in a simultaneous procedure with three operations in only one setting. The perioperative features of this special case are reflected in the following course.