Pectus excavatum is a known manifestation of Marfan disease and, when coexisting with aortic diseases imposing surgical intervention, its treatment is performed in simultaneous surgery. We describe a 29-year old man affected by Marfan syndrome, who underwent a Tirone David intervention for Valsalva sinuses dilatation and in concomitance a Ravitch procedure was needed. The patient had already undergone an esthetical intervention for the thoracic deformity, but the preoperatory CT found a severe form of pectus, which imposed the aortic and thoracic correction in one single time. Surgery and postoperative outcome were satisfactory.