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Key clinical message Left ventricular apical hypertrophic cardiomyopathy with an apical aneurysm carries a risk of thrombosis and can also lead to atrial fibrillation and functional mitral regurgitation. Abstract A 78‐year‐old woman underwent left ventricular apical aneurysm (LVAA) resection and mitral valve replacement for severe atrial functional mitral regurgitation. ApHCM can cause atrial fibrillation and atrial functional mitral valve regurgitation. LVAA resection in addition to mitral valve replacement was reasonable to prevent fatal complications associated with LVAA.