Left Ventricular Apical Aneurysm and Ventricular Tachycardia in a Patient With Bicuspid Aortic Valve and Hypertrophic Cardiomyopathy

A 36-year-old man, who had a history of aortic valve replacement 8 years previously because of severe aortic stenosis and bicuspid aortic valve, presented to the emergency department with a hemodynamically unstable ventricular tachycardia. Echocardiography showed an asymmetrical left ventricular hypertrophy and a normal functioning prosthetic valve with a negligible transvalvular gradient and no evidence of patient-prosthetic mismatch. Cardiac magnetic resonance imaging revealed left ventricular hypertrophy with an apical aneurysm, diffuse late gadolinium enhancement, and a midcavitary obstruction, all in favor of hypertrophic cardiomyopathy. Ventricular tachycardia ablation was done via the trans-septal approach, and an implantable cardioverter-defibrillator was inserted.