A 23-Year-Old Man Is Evaluated for a Murmur Discovered at a Health

A 23-year-old man is evaluated for a murmur discovered at a health fair.  His past medical history is insignificant, and he feels well with no cardiac symptoms.  The patient plays soccer and jogs regularly.  His immediate family is healthy.  Blood pressure is 122/70 mm Hg and pulse is 72/min.  A 2/6 midsystolic murmur is heard at the left sternal border.  The femoral pulses are full, and there is no brachial-femoral pulse delay.  Echocardiography shows bicuspid aortic valve with a mildly increased gradient and no dilation of the aortic root.  Which of the following is the best next step in management of this patient?

A) Angiography to rule out coronary artery anomaly
B) Aortic valve replacement
C) Balloon valvuloplasty
D) Doppler ultrasound for renal artery stenosis
E) First-degree relative screening with echocardiography

Correct Answer:

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