This report describes our experience in performing mitral valve replacement and tricuspid annuloplasty via a right mini-thoracotomy in a patient with tracheostomy. A 24-year-old woman was admitted with shortness of breath and palpitations. She had subglottic tracheal stenosis and tracheostomy due to tracheal intubation of long duration. Echocardiography revealed chronic severe mitral and tricuspid valve regurgitation. We planned to perform at first the cardiac, and then the tracheal operation, because her left ventricular function was worsening. To eliminate the potential complications of sternotomy in patients with tracheostomy, we used right mini-thoracotomy. We performed mechanical mitral valve replacement for the mitral valve and De Vega annuloplasty for the tricuspid valve. The patient was transferred to the tracheal surgery clinic after the 20th day. Tracheal resection and anastomosis were performed in this department. Three months later, the patient was asymptomatic. We believe that the right mini-thoracotomy approach is a good technique for mitral valve replacement in patients with tracheostomy.