The Correct Answer is B!

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A 33 year-old man with a known bicuspid aortic valve is seen for follow-up. He is active, runs 2-3 miles per day and denies symptoms or any other medical problems. He is not on any medications. On exam, BP 122/40 and HR 55. Bounding carotid pulses with normal JVP and clear lung fields. The LV is displaced and enlarged. There is a 2/6 short SEM at the RUSB with an early peak and a long 3/6 diastolic decrescendo murmur is audible at the LSB. Echocardiography shows a dilated LV with EF 55% and ESD 41 mm and EDD 60 mm. There is a bicuspid aortic valve with a eccentric jet of AR with severe flow reversal in the descending aorta. There is a 8 mmHg mean gradient across the aortic valve. The aortic root and ascending aorta were well visualized and normal in size.

What is the next step in management?

  1. Start vasodilator and see in 3 months with echocardiogram.
  2. Continue observation with serial echocardiograms every 6 months.
  3. Proceed with AVR or repair
  4. Right and left heart catheterization with aortic root angiography

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