Patients with degeneration of a prosthetic mitral valve can be treated with minimally invasive transcatheter mitral valve in valve (TMViV) intervention, guided via fluoroscopic and echocardiographic intra-procedural imaging. However, despite the significant improvements in treatment outcomes and patient safety brought by the TMViV intervention, this procedure involves several steps requiring a highly skilled and experienced operator to be performed safely. Simulation-based procedural training has become a valuable method for efficiently facilitating the learning process for young operators across various types of interventions. The aim of this study was to present a new high-fidelity simulator featuring patient-specific anatomy and to demonstrate its potential impact on the procedural training for TMViV. The simulator was based on computed tomography to replicate the anatomy of a real patient using additive manufacturing. The intra-procedural imaging view were implemented with an ad-hoc positioning and orientation of specific cameras to reproduce the structures and anatomical landmarks displayed during the procedure via fluoroscopy and echocardiography. The entire TMViV procedure was simulated with real clinical instrumentation, including prosthetic and implanted valves, by expert operators demonstrating the feasibility of the simulator to be used as a realistic replicator of the anatomies involved during the intervention and the intra-procedural imaging views. The simulator represents a significant advancement in training capabilities, potentially improving procedural outcomes and patient safety in TMViV interventions.