A 75-year-old female who visited the Outpatient Department presented with dyspnea (NYHA III) and syncope. She underwent mitral valve replacement (MVR) in 1988 and 2000. The laboratory data showed hemolytic anemia (hemoglobin 6.4 g/dL, reticulocyte count 7.72%, total bilirubin 1.76 mg/dL) and she needed red blood cell (RBC) transfusion every 3-4 weeks. There was severe eccentric paravalvular leakage (PVL) on color Doppler transesophageal echocardiography (TEE) (Figure 1A). The patient refused tri-do valve surgery and the cardiac surgeon expressed that MVR might not reduce PVL due to fibrotic changes to the mitral annulus after re-do MVR. We decided to do transcatheter implantation of a vascular plug into the slit between the prosthetic valve and mitral annulus. The EchoNavigator system (Phillips Healthcare, Best, The Netherlands) was used to find the slit and wiring (Figure 2, Movie 1). Two Amplatzer Vascular Plugs™ (8 mm and 10 mm) were deployed (Figure 3). After the procedure, hemolysis was improved and no further RBC transfusions were required.