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Eur Heart J Case Rep
Eur Heart J Case Rep
ehjcr
European Heart Journal. Case Reports
2514-2119
Oxford University Press UK

10.1093/ehjcr/ytae469
ytae469
Images in Cardiology
AcademicSubjects/MED00200
Eurheartj/31
Eurheartj/33
Eurheartj/35
Eurheartj/32
Eurheartj/38
Eurheartj/48
Eurheartj/49
Eurheartj/39
Eurheartj/41
Congenital aneurysm of the muscular interventricular septum in an elderly patient
https://orcid.org/0000-0002-7636-7453
Zhou Tingquan Department of Cardiology, Shanghai Sixth People’s Hospital, No.600, Yishan Road, Xuhui District, Shanghai 200233, China

Shen Chengxing Department of Cardiology, Shanghai Sixth People’s Hospital, No.600, Yishan Road, Xuhui District, Shanghai 200233, China

Jensen Christoph Handling Editor
Albulushi Arif Editor
Rroku Andi Editor
Corresponding authors. Tel: +021 24058386, Email: bdztq1982@163.com (T.Z.); Tel: +021 24058386, Email: shenchienx2@hotmail.com (C.S.)
Conflict of interest: None declared.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

State Scholarship Fund 202106235020 Hospital Clinical Retrospective Research Fund ynhg202409
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pmcA 69-year-old woman was referred for cardiac evaluation after a health check-up electrocardiogram revealed T-wave deflections. She had no history of cardiac evaluations, treatments, or significant cardiovascular risk factors. Transapical echocardiography revealed an aneurysm in the muscular portion of the interventricular septum without a left-to-right shunt. Coronary angiography confirmed normal coronary arteries. Left ventricular angiography is shown in the Supplementary video. Advanced imaging with cardiac computed tomography angiography and magnetic resonance imaging (MRI) further revealed a large aneurysm in the muscular interventricular septum, with a diameter comparable to that of the thoracic aorta and no evidence of thrombosis. Given the absence of symptoms and haemodynamic impact, a conservative management approach was adopted, including lifestyle modifications, routine cardiac monitoring, and regular follow-up. Prophylactic anticoagulation was considered but deemed unnecessary because of the absence of thrombosis, stable haemodynamic status, and lack of additional risk factors. Although this decision could increase the risk of thrombus formation, normal blood flow within the aneurysm prevents antithrombotic therapy, thereby reducing the risk of bleeding. The patient was scheduled for echocardiography every six months to monitor the aneurysm, with MRI as needed. Throughout the follow-up period, the patient remained asymptomatic with no new findings, thus adhering to the original monitoring plan. Muscular interventricular septal aneurysms are rare in adults and often diagnosed incidentally.1 They are primarily linked to congenital factors from embryonic development, with genetic and environmental influences also playing a role. Acquired causes, such as myocardial infarction or trauma, are less common. In this case, unlike others associated with coronary disease or septal defects,2,3 the patient had normal coronary arteries and no history of heart disease, suggesting a congenital origin with slow progression. Despite being asymptomatic, there remains a risk of complications such as thromboembolism or arrhythmias, necessitating personalized follow-up every 6–12 months, with surgical intervention reserved for significant aneurysm enlargement or complications (Figure 1).

Figure 1 Electrocardiogram, coronary angiography, transthoracic echocardiography, computed tomography angiography (CTA), and magnetic resonance imaging (MRI). Electrocardiogram reveals T-wave deflection in leads 2–4. Left ventriculography revealed the aneurysm (C). A transapical view with echocardiography revealed the aneurysm (D). A large aneurysm in the muscular interventricular septum was found on both CTA and MRI (E and F). The diameter of the aneurysm is comparable to the diameter of the thoracic aorta.

Supplementary Material

ytae469_Supplementary_Data

Supplementary material

Supplementary material is available at European Heart Journal – Case Reports online.

Consent: This study was conducted following the guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of the hospital. Written informed consent was provided, and the patients’ personal data were secured.

Funding

This research was funded by the State Scholarship Fund (no. 202106235020) to T.Z., and the Hospital Clinical Retrospective Research Fund (no. ynhg202409) to T.Z.

Data availability

The original data are available from the authors upon reasonable request.
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References

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3 Kawahira T , MiyashitaF, SuzukiT. Rare case of ruptured muscular ventricular septal aneurysm due to silent myocardial ischemia in adult. J Surg Case Rep 2022;5 :rjac114.
