The evolution of basal septal hypertrophy: From benign and age‐related normal variant to potentially obstructive and symptomatic cardiomyopathy

Localized thickening of the basal portion of the ventricular septum or basal septal hypertrophy (BSH) has been identified both at autopsy and by imaging studies for decades; despite numerous investigations, there is no consensus on the significance of this finding and a remarkable lack of consistency in terminology. This paper summarizes the scientific literature on the topic, focusing on recent echocardiographic findings. A case description illustrating some of the complex issues involved in measurement and diagnosis and differentiation from sigmoidal hypertrophic cardiomyopathy (HCM) is presented. Criteria are proposed for diagnosing pathologic BSH which include the following: (1) Exertional symptoms compatible with left ventricular outflow tract obstruction (LVOTO) such as dyspnea, near‐syncope, and chest discomfort; (2) Documented LVOTO gradient demonstrated at peak bicycle or post‐treadmill exercise >30 mm Hg; and (3) Symptomatic improvement with β‐blocker (or other negative inotropic) therapy (preferably accompanied by documentation of reduction of exercise‐induced LVOT).