Transcatheter mitral valve-in-valve replacement is increasingly being performed as operator and center experience in transcatheter valve replacement technology and techniques have accrued. Complications, such as valve embolization and paravalvular regurgitation, still occur and relate to valve deployment. The use of novel imaging techniques, such as 3D echocardiography, allows for better differentiation of cardiac structures and appropriate positioning of the transcatheter valve using well-visualized anatomical landmarks. Here the authors describe in images and video the use of 3D echocardiography for deployment of a mitral valve-in-valve.