Long-term, natural course of congenital heart defect often results in secondary hemodynamic and functional disorders in adult life. In such cases, first clinical manifestations are generally due to age-related accompanying or secondary pathology rather than with the defect itself. In the presence of concomitant ischemic heart disease (IHD), leading manifestations may be those of angina, which mask manifestations of the heart defect and complicate the diagnosis. Not infrequently in practice, patients refuse surgery in a younger age, which is usually due to their satisfactory condition and an absence of complaints. However, the wait and see tactics is not always justified since over time, hemodynamic disturbances progress, complications of the defect may develop, coronary arteries lesions join with age, and their correction requires an integrated approach. The presented clinical case describes a possibility of successful one-stage surgical correction of an atrial septal defect, tricuspid valve regurgitation, atrial fibrillation, and IHD in a 62-old female patient.