We report a patient with Marfan's syndrome and pectus excavatum who underwent open heart surgery with simultaneous correction of the sternal malformation. Permanent internal stabilization, achieved by bilateral overlapping of the bevelled ends of the lowest ribs and reinforced with sternal closure wires offered a maintained postoperative chest wall stability, avoided the potential postoperative complications of cardiac compression, and improved the aesthetic appearance of the anterior chest wall. The increased risk of bleeding due to extensive dissection was minimized by postponing the repair of pectus excavatum to when protamin is administered after termination of cardiopulmonary bypass.

Interlayer dissection of the atrial septum resulting in the formation of a cavity developed after an attempted repair of a mitral paraprosthetic leak. Subsequent rupture of the cavity into both atria resulted in a small left-to-right shunt and significant left ventriculoatrial regurgitation. Misplaced stitches, aimed at obliterating the paraprosthetic leak, were the cause of the dissection. This case illustrates a previously unreported complication of mitral valve surgery and stresses the importance of proper exposure and handling of the mitral annulus.