Obstruction to left ventricular inflow secondary to combined mitral annular calcification and idiopathic hypertrophic subaortic stenosis

We present an elderly woman with idiopathic hypertrophic subaortic stenosis (IHSS) and obstruction to left ventricular inflow. The inflow obstruction is thought to be due to massive mitral annular calcification. The association of IHSS and inflow obstruction is rare and may be overlooked unless careful hemodynamic measurements are obtained.