Congenital muscular ventricular septal aneurysm coexisting with a pericardial cyst, a case report

Muscular ventricular septal aneurysm (VSA) is commonly caused by myocardial infarction, myocarditis or trauma, but it may occasionally be congenital. For congenital VSA, the diagnosis is challenging, and the therapeutic strategy and prognosis remain uncertain.

A 32-year-old man was admitted following a detection of left ventricular aneurysm on echocardiography during a routine health checkup. The patient was asymptomatic, the echocardiography showed an aneurysm in the midventricular septum associated with regional hypokinesis, accompanied by left ventricular dilation and reduced left ventricular ejection fraction (LVEF) of 46%. Coronary computed tomography angiography and cardiac magnetic resonance localized the muscular VSA and revealed a cyst at the anteroinferior margin of the pericardium, further coronary angiography was unremarkable. Laboratory findings such as cardiac markers, rheumatologic, immunologic and inflammatory markers were within normal limits. The diagnosis of congenital muscular VSA coexisting with a pericardial cyst was considered. Pharmacological treatment for heart failure was initiated to prevent further reduction in LVEF. At the 3-month and 1-year follow-ups the patient remained asymptomatic, and echocardiography demonstrated the LVEF increased from 50% to 57%.

Congenital muscular VSA is an uncommon cardiac abnormality that may be accompanied by impaired cardiac function. Treatment for heart failure could improve the cardiac function.