INTRODUCTION
Hemophilia A is a rare X-linked bleeding disorder caused by mutations in the gene that encodes factor VIII (FVIII) with a prevalence of 1/5000 live male births.1 Disease severity is based on FVIII levels in the blood: the severe form is defined as a factor level < 1% of normal, the moderate form as a factor level of 1–5%, and the mild form as a factor level between 5% and 40%.2 Cardiac surgery in patients with severe hemophilia remains a serious problem due to the risk of large intra- and postoperative blood loss, absence of evidence-based guidelines regarding factor replacement therapy, and anticoagulation treatment after valve intervention using cardiopulmonary bypass. Here, we report the successful, minimally invasive treatment of mitral valve insufficiency and concomitant atrial fibrillation (AF) in a patient with severe hemophilia A.