The patient is a 76-year-old woman. She had undergone double valve replacement for rheumatic mitral and aortic valve regurgitation at the age of 64. She was diagnosed with chronic obstructive pulmonary disease (COPD) at 73 years old (Hugh-Jones class IV) . She was admitted to our hospital because of severe hemolytic anemia at 76 years old. Perivalvular leakage of mitral prosthetic valve was noted by transesophageal echocardiography. Preoperative respiratory physiotherapy was performed (breath muscle training, expectoration of sputum training, a therapeutic exercise, and Souffle training) for 3 weeks, because she was a high risk patient for postoperative respiratory complications. Her respiratory function (vital capacity, FEV1.0) was improved. Re-replacement of the mitral valve was performed using On-X valve 23 mm. She was extubated on the 1st postoperative day, and her postoperative course was uneventful. Preoperative respiratory physiotherapy might be very important for patients with COPD to prevent post operative pulmonary complications.