The Correct Answer is D!

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A 44 year-old man with a known bicuspid aortic valve presents with one year of increasing DOE. On exam, he has a BP 155/50, brisk pulses, and a 3/6 diastolic decrescendo murmur at the LSB. Echocardiography shows a dilated LV (LVEDD 68/LVESD 40) with EF 66%. There is a bicuspid aortic valve with a thin eccentric jet of AR, called mild AR in report. The aortic root is normal in size.

What is the next step in management?

  1. Surgical referral
  2. Observe with follow-up in 6 months
  3. Exercise MUGA
  4. Aortic root angiography

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