What would you do now?

A 7-2year-old man presents with increasing symptoms of dyspnea and chest pain
on exertion over the past 6 months. He had 2 episodes of near syncope
while climbing stairs. No prior cardiac history.
■ BP 130/50 mmHg and pulse 70 bpm
■ JVP normal and 2 carotid delay
■ LV sustained and displaced; S4 present
■ 2/6 SEM at the base with mid peak
■ 2/6 diastolic decrescendo murmur
Echocardiography
■ Moderately dilated LV cavity
■ Mild LVH
■ Mild LA enlargement
■  Calcified Aortic Valve
■ Mean aortic valve gradient 25mmHg
■ AR probably mild

What would you do now?
a. TEE
b. Coronaries then AVR
c. TMET
d. Cardiac catheterization with arterial-venous gradient, CO, root, and coronary
angiography
e. Medical observation




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