A 45-year-old man underwent trans-aortic myectomy for hypertrophic obstructive cardiomyopathy (HOCM). Although two mounds of hypertrophic septal muscle were resected, Brockenbrough phenomena proved unsatisfactory myectomy. Intraoperative trans-esophageal echocardiogram (TEE) revealed a residual mound at the apical septum. After the additional myectomy, Brockenbrough phenomena was disappeared. Intraoperative TEE is an useful supplement in the operation of transaortic myectomy for HOCM.
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