A 78-year-old woman with a history of hypertension was admitted to the intensive care unit for cardiogenic shock. Results of physical examination showed low systolic blood pressure (85 mmHg), tachycardia, severe dyspnoea and a loud systolic murmur. Echocardiography revealed an increased left ventricular ejection fraction (75%) with asymmetrical myocardial hypertrophy (septum 30 mm, posterior wall 9 mm), severe left ventricular obstruction gradient (110 mmHg) and mitral regurgitation (MR) caused by a prominent systolic anterior motion and posterior leaflet restriction, resulting in a large coaptation defect ( Fig. 1 , Movies 1 and 2 ). Despite mechanical ventilation, isotonic saline perfusion and beta-blocker therapy (atenolol 5 mg), the patient remained unstable and inotropic support was introduced (dobutamine and norepinephrine). Because of haemodynamic instability and persistent left ventricular obstruction and MR, the patient was eventually referred for a septal alcoholization monitored by a contrast-ultrasound agent ( Fig. 2 ). This was followed by a rapid improvement in blood pressure and decreases in MR and left ventricular obstruction ( Fig. 3 and Movie 3 ). Inotropic support and mechanical ventilation were withdrawn over the following days.
