Mid-ventricular obstructive hypertrophic cardiomyopathy is rare and often complicated by apical ventricular aneurysm, which can cause life-threatening ventricular arrhythmias. A 76-year-old male patient came to our hospital because of an electrocardiogram abnormality (giant T-wave inversion). Transthoracic echocardiography showed myocardial hypertrophy at the level of the papillary muscles, apical thinning, and aneurysm formation. The patient was diagnosed with mid-ventricular obstructive hypertrophic cardiomyopathy with apical ventricular aneurysm. During follow-up, the patient developed exertional dyspnea, and nonsustained ventricular tachycardia was noted on Holter monitoring. Therefore, we opted for surgical treatment. The patient was placed on cardiopulmonary bypass and treated with apical aneurysmectomy, followed by myectomy with a trans-apical approach. Postoperative echocardiography showed an increased left ventricular end-diastolic volume. The patient no longer had difficulty breathing and did not develop postoperative ventricular arrythmia. He has been uneventful six months after surgery. We considered surgical treatment was effective in treating arrhythmias and heart failure.