21. Which of the following is NOT an indication for aortic valve replacement?

A. An asymptomatic patient with severe aortic stenosis when the left ventricular systolic function reduced to 45% from normal 1 year prior.

B. A dyspneic patient with a mean pressure gradient of 42 mmHg across the aortic valve

C. A patient with an aortic valve area of 0.9 cm2 who was able to exercise 12 minutes on a Bruce protocol and complains of no symptoms

D. A patient with a mean aortic valve pressure gradient of 30 mmHg, left ventricular ejection fraction of 30% and a dimensionless index of 0.20.