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Percutaneous transluminalseptal myocardial ablation (PTSMA), has been a standard treatment of hypertrophic cardiomyopathy (HCM). Rarely, special technique of PTSMA needed for complicated HCM case with collateral of target artery (septal perforator) into distal left anterior descending. To overcome such problem, a case of double balloon technique during PTSMA will be elaborated.