Percutaneous transluminal septal myocardial ablation (PTSMA) is an accepted strategy to reduce dynamic left ventricular outflow tract (LVOT) obstruction in HOCM. Periinterventional intramyocardial 2D contrast echocardiography (2D-CE) is the primary imaging technique to identify the interventional target region. The role of intramyocardial 3D-CE in a PTSMA procedure has not been described yet. Real time 3D technique will be able to present an “instantaneous overlook” of the target myocardium in 4 dimensions (3D + time), which may increase speed and safety of the procedure. We present a case with HOCM undergoing PTSMA under additional 3D-CE control of the target area.