Asymptomatic Pediatric Hypertrophic Cardiomyopathy Diagnosed as Midventricular Obstruction by Exercise Stress Echocardiography

Abstract

Midventricular obstruction (MVO) is a risk factor for sudden cardiac death in patient with hypertrophic cardiomyopathy (HCM). Report of MVO in children are rare. Thus the clinical picture is unclear, and no established management approaches exist. Here, we report asymptomatic HCM with MVO diagnosed with exercise stress echocardiography in a 15-year-old boy. The resting echocardiogram showed progressive myocardial hypertrophy in the middle ventricular septum, and the exercise stress echocardiogram showed a severe pressure gradient in the same area. Due to the exercise stress echocardiography findings, beta blocker treatment was initiated and exercise was restricted. Exercise stress echocardiography may be useful for the early detection of significant MVO in childhood cases of asymptomatic hypertrophic cardiomyopathy.