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A seven-year-old Shih Tzu with refractory repeated pulmonary edema and syncope was presented for surgical operation. From the results of cardiovascular examinations, the dog was diagnosed as severe mitral regurgitation (ACVIM consensus class D) and mild tricuspid regurgitation. The dog first underwent surgery with mitral valve plasty; however, the results were unsatisfactory due to severe damage of the whole mitral valve. The operation was quickly changed to mitral valve replacement using a mechanical valve (19 mm). The dog survived surgery and lived for 2 years and one month after operation using long-term anticoagulant (warfarin) therapy in spite of several thrombosis-related events.