Lost Patients: Adult Congenital Heart Disease
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A 41-year-old man presents to the emergency department with left hand and upper extremity weakness and numbness, as well as left lower facial numbness.
Past surgical history is notable for surgical valvotomy on day of life four (1974) for pulmonary valve stenosis. He did well thereafter, and at three-year follow-up, his family was told that he was healthy and no longer needed ongoing cardiac care. His primary care physician follows him for hyperlipidemia, for which he is on a daily aspirin and statin medication. He is a never smoker and has no significant family history of coronary or cerebrovascular disease.
During his admission, his neurologic symptoms nearly resolve with the exception of left thumb numbness. He is diagnosed with a cerebrovascular accident and his evaluation included head computed tomography (normal), carotid duplex ultrasound (normal), hypercoaguable evaluation (normal), and echocardiogram to evaluate for patent foramen ovale.
The echocardiogram demonstrates a small left-to-right atrial level shunt, dilated right ventricle, severe pulmonary valve insufficiency, and moderate tricuspid insufficiency. Exercise stress test reveals mild, non-specific ST-T changes with maximal workload of 13.7 METS.
Which of the following statements describes the next step in the management of this patient?