A female patient was admitted to our institution because of congestive heart failure. She was affected by severe aortic valve disease (stenosis with regurgitation) and she had a good functioning mechanical mitral valve, implanted 9 years ago. After multidisciplinary team discussion, the patient was refused for surgery and shifted to transfemoral aortic valve implantation. A 23-mm Edwards Sapien XT valve (Edwards Lifesciences, Irvine, California, USA) was successfully implanted by totally percutaneous transfemoral approach with local sedation and spontaneous breathing. Both the prostheses had good function at the end of procedure. We present the images of this case, demonstrating the feasibility of transcatheter balloon-expandable aortic valve implantation even in the presence of a mechanical mitral valve.