Cardiovascular Medicine Q 3

A 65-year-old woman is evaluated during a routine examination. She was diagnosed with a cardiac murmur in early adulthood. She is active, healthy, and without symptoms. She takes no medications.

On physical examination, vital signs are normal. A grade 3/6 holosystolic murmur preceded by multiple clicks is present at the apex. Physical findings are otherwise unremarkable.

An echocardiogram demonstrates a left ventricular ejection fraction of 50%. The left ventricle is moderately dilated with an end-systolic dimension of 42 mm. Myxomatous degeneration of the mitral valve is present with severe regurgitation due to posterior leaflet prolapse.

Which of the following is the most appropriate next step in management?

A Serial clinical and echocardiographic evaluations

B Surgical mitral valve repair

C Surgical mitral valve replacement

D Transcatheter mitral valve repair

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