We report the case of a patient with mesocardia, mitral restenosis, and mitral regurgitation. He had undergone an open mitral valvotomy 4 years earlier and, therefore, presented us with a problematic approach to the mitral valve. In such cases, access to the mitral valve is almost impossible due to the position of the valve, which is more posterior and to the left of a normal valve, and due to adhesions from the previous surgery We approached the mitral valve through the left atrial appendage and replaced the mitral valve with a mechanical prosthesis.