We developed a needle stick technique for treating hypertrophic obstructive cardiomyopathy. Three 21-gauge needles are inserted into the interventricular septum just below the aortic valve annulus beyond the far side of the septal bulge. The right and left needles are both side margins, and the center needle is a guide for the thickness. Each needle plays a role as a mark of resection for the width, length, and thickness. The needles also stabilize the ventricular septum and provide good exposure of the entire septal hypertrophy. This technique is helpful to safely achieve sufficient septal myectomy of a constant thickness. (Ann Thorac Surg 2013;95:726-8) (c) 2013 by The Society of Thoracic Surgeons