During the course of 1974, 16 tympanoplasties were performed on patients who suffered from serious congenital heart defects. 50 % of the cases had recurrence of the perforation. It was not possible to deny the evidence of other failing factors such as the poor hemodynamic condition. Indications for performing a tympanoplasty were motivated by the necessity to eliminate a focus of dangerous infection to the patient before undergoing a major cardiac intervention. These indications have been modified to the following: (a) chronic cholesteatomatous otitis remains a valid surgical indication and (b) simple chronic otitis could be controlled by local medical treatment. The tympanoplasty could be postponed after the cardiac intervention when the hemodynamic condition had been corrected.