Congenital Aneurysm of the Muscular Interventricular Septum in an Elderly Patient

A 69-year-old woman with an unremarkable medical history was referred for cardiac evaluation after an abnormal electrocardiogram (ECG) revealed T-wave deflections in leads 2–4. Advanced imaging, including echocardiography, coronary angiography, computed tomography angiography (CTA), and magnetic resonance imaging (MRI), identified a large congenital aneurysm in the muscular interventricular septum without thrombosis. Given the absence of symptoms and significant hemodynamic impact, a conservative management approach was adopted, including regular follow-up with periodic echocardiography. Prophylactic anticoagulation was considered but deemed unnecessary due to the stable condition and lack of thrombosis. The patient remained asymptomatic with stable vital signs throughout the follow-up period. This case underscores the importance of routine cardiac evaluations, advanced imaging, and long-term monitoring in managing rare cardiac anomalies like congenital muscular interventricular septal aneurysms.