We present the case of a 64-year-old high-risk male with a history of mitral valve (MV) endocarditis post-MV replacement (MVR) in 2005, complicated by MV prosthesis dehiscence due to recurrent endocarditis that required MV re-replacement one year later. Additional co-morbidities include atrial flutter, gastrointestinal bleeding, anemia, chronic kidney disease, and metastatic pancreatic islet cell tumor. In 2018, he represented with class IV congestive heart failure despite maximal medical therapy. An echocardiogram showed severe tricuspid regurgitation (TR), a significantly dilated and dysfunctional right ventricle (RV), and structural MV prosthesis degeneration with severe mitral regurgitation (MR). He was subsequently transferred to our reference center for definitive management.