Background <p>Minimally invasive mitral valve surgery has gained increasing acceptance for selected mitral valve procedures owing to its potential to minimize surgical trauma and enhance postoperative recovery. However, the adoption of advanced technologies such as three-dimensional endoscopic systems may be limited in resource-constrained environments.</p> Case presentation <p>We report the case of a 62-year-old Vietnamese female patient with a history of rheumatic heart disease and mitral regurgitation who underwent totally endoscopic mitral valve replacement using two-dimensional endoscopic visualization and percutaneous peripheral cardiopulmonary bypass. Despite the unavailability of a functional three-dimensional system, the surgery was successfully completed using two-dimensional support and percutaneous cannulation via the femoral artery and vein. Postoperative echocardiography confirmed good cardiac function without paravalvular leakage, and the patient was discharged on the fourth postoperative day.</p> Conclusion <p>This case demonstrates the feasibility and effectiveness of performing totally endoscopic mitral valve replacement with two-dimensional endoscopic support and percutaneous cardiopulmonary bypass. These minimally invasive techniques can be successfully applied in settings with limited access to advanced technology, offering promising outcomes for mitral valve surgery.</p>