A 70-year-old man, diagnosed with severe mitral regurgitation and moderate tricuspid regurgitation with situs inversus totalis, was referred to our hospital. A minimally invasive approach via a minithoracotomy was performed. The mitral valve was repaired with the loop technique and ring annuloplasty. With an asymmetric shape of the tricuspid valve, the use of a conventional rigid ring was not feasible. Therefore, flexible ring annuloplasty had to be performed. The minimally invasive approach for mirror-image anatomy did not pose an unusual technical challenge. It was safely performed in the context of situs inversus totalis.
