Introduction: Surgical septal myectomy has brought a considerable increased survival from all cause mortality and even hypertrophic cardiomyopathy related mortality in comparison with unoperated hypertrophic cardiomyopathy. Case presentation: Case PresentationA fifty-five man who referred to Tehran Heart Center Hospital in April 2009 with dyspnea on exertion grade (NYHA class III) and chest pain (NYHA grade II) and occasional palpitation. Conclusion: The left ventricular outflow tract gradient increment leads to hemodynamic obstruction. The recommended treatments for patients with this problem varied from medical treatments to surgical myectomy and septal ablation. We herein depicted the multi problem case which undertaken multiple management in one operation