The case is reported of severe rheumatic mitral stenosis (MS) associated with asymptomatic inferior vena cava (IVC) occlusion, detected incidentally while performing percutaneous balloon mitral valvotomy (PBMV). The patient successfully underwent a single-stage balloon dilatation of the membranous obstruction in the IVC, followed by PBMV using the Inoue technique. The case represents a rare, incidental concurrence of IVC obstruction and severe rheumatic MS. This rare hybrid percutaneous sequential balloon dilatation is the first of its type to be reported, and highlights the growing experience of percutaneous interventional techniques in the management of such complex cases.