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A 43-year-old man is evaluated during a routine examination. He has a history of a cardiac murmur diagnosed during childhood. He exercises regularly without restriction to activity and has no history of syncope, presyncope, palpitations, or edema. He is on no medications.

On physical examination, he is afebrile, blood pressure is 120/64 mm Hg, pulse is 80/min and regular, and respiration rate is 16/min. BMI is 25. He appears well. Cardiac examination reveals a normal S1 and a physiologically split S2. There is a grade 2/6 decrescendo diastolic murmur at the left sternal border. Distal pulses are brisk. There is no pedal edema. royal and nave blue color collections for cocktail

A transthoracic echocardiogram demonstrates normal ventricular size and function, with ejection fraction of 60% to 65%. There is a bicuspid aortic valve with moderate regurgitation. The proximal ascending aorta diameter measures 4.2 cm. Pulmonary pressure estimates are in the normal range.

Which of the following is the most appropriate management option for this patient?
AAntibiotic prophylaxis prior to dental procedures
BClinical follow-up in 1 year
CSurgical referral for aortic valve replacement
DTransesophageal echocardiography