Advanced myocardial disease associated with a post-intubation tracheal stenosis due to acute cardio-pulmonary failure in a 52 year-old patient led to a difficult choice of priorities between tracheal resection-anastomosis and heart transplantation. A simultaneous surgical operation with both heart transplantation and tracheal resection-anastomosis was considered to be a safe solution and was performed successfully. No adverse effect of corticosteroid and immunosuppressive therapy was observed on tracheal healing despite the tension resulting from segmental resection of the trachea.