Dynamic left ventricular outflow tract (LVOT) obstruction caused by systolic anterior motion (SAM) of the mitral valve is observed in variable clinical conditions with anatomical or functional abnormalities of LVOT and mitral valve. Several treatment options to relieve obstruction have been suggested including medications to change the contractility of left ventricle, volume reduction of interventricular septum by surgical or non-surgical catheter-based intervention, and surgical correction of the abnormal mitral valve. Here we reported a case of 48-year-old man who presented with shortness of breath. After repeated alcohol septal ablation, mitral valve replacement was finally performed to achieve complete symptom relief.