Extra Tissue is the Issue

An asymptomatic 43-year-old Ukrainian female presented to the outpatient office for a second opinion. After the birth of her second child in 2005, a murmur was auscultated. A transthoracic parasternal long axis echocardiogram image is shown in Figure 1. Annual echocardiograms revealed a gradual increase in the gradient across the pathology of concern. In March 2015, ten years since the initial presentation, select apical outflow tract images from a follow-up echocardiogram are shown in Figure 2 and Figure 3. A transesopahegeal echocardiogram, a select image of which is shown in Figure 4, confirmed the aforementioned findings.

Figure 1: Transthorcic Parasternal Long axis view (Video)

Figure 2: Transthoracic Apical 5 chamber view (Video)

Figure 3: Pulse Doppler interrogation, Transthoracic Apical 5 chamber view (Image)

Figure 3

Figure 4: Select views from a transesophageal echocardiogram with color Doppler (Video)

What is the next best step for this asymptomatic patient?

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