In this Masters of Cardiothoracic Surgery, Meier and colleagues outline their approach to transmitral myectomy and surgical management of systolic anterior motion in a case vignette of a 45-year-old male with hypertrophic cardiomyopathy. The technique combines a transmitral left ventricular myectomy and a resuspension of the anterior mitral leaflet with a partial, flexible annuloplasty. The perils and pitfalls of this technique are presented in this article, which is accompanied by a narrated video with operative footage.