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Left ventricular outflow tract obstruction (LVOTO) is a notorious complication of transcatheter mitral valve replacement (TMVR). Computed tomography-derived simulations can predict neo-LVOTO post-TMVR, whereas alcohol septal ablation (ASA) can mitigate neo-LVOTO risk. We report a case of sequential ASA of 2 adjacent septal branches to resolve unexpected neo-LVOTO post-TMVR., Competing Interests: Dr Van Mieghem has received grants or contracts from Abbott, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, PulseCath BV, Abiomed, and Daiichi Sankyo; consulting fees from JenaValve, Daiichi Sankyo, Abbott, Boston Scientific, and Medtronic; payment or honoraria for lectures, presentations, speakers, manuscripts, and educational events from Abiomed and Amgen; and support for attending meetings and/or travel from JenaValve. Dr Daemen has received grants or contracts from AstraZeneca, Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, MicroPort, Pie Medical, and ReCor Medical; and consultancy and speaker fees from Abbott Vascular, Abiomed, ACIST Medical Systems, Boston Scientific, Cardialysis BV, CardiacBooster, Kaminari Medical, ReCor Medical, PulseCath, Pie Medical, Sanofi, Siemens, and Medtronic. Dr Hirsch has received grants and consultancy fees from GE Healthcare; speaker fees from GE Healthcare and Bayer; and is a member of the medical advisory board of Medis Medical Imaging Systems. Dr de Sá Marchi is supported by a PhD Scholarship for International Research from “Conselho Nacional de Desenvolvimento Científico e Tecnológico-Brasil (CNPq)” under grant 88887.716769/2022-00. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)