Cardiac magnetic resonance imaging in late systole. In this patient, two mechanisms of SAM were postulated. One was that the tips of papillary muscles anomalously deviated anteriorly. The papillary muscles were connected with the septum with abnormal fibrous tissue and touching the septum in systole. The other mechanism involves the elongated anterior leaflet. It was turned over by the blood flow through LVOT, as described by Schwammenthal et al.