Aortic Stenosis Case #5

A 72-year-old male with obesity presents with dyspnea and edema. He has a III/VI systolic ejection murmur radiating to the carotid arteries. The S2 heart sound is audible, but soft. An echocardiogram revealed normal left ventricular systolic function and aortic stenosis with a mean pressure gradient of 30 mm Hg. The aortic valve area is 0.8 cm2. Which of the following is the most appropriate next step?

A. Surgical aortic valve replacement after coronary angiography

B. Cardiac catheterization for hemodynamic assessment of the aortic valve

C. Transesophageal echocardiography

D. Medical therapy only and repeat an echocardiogram in 1 year

E. Treadmill stress testing