Although this patient has severe aortic stenosis based on quantitative echocardiographic findings, he is asymptomatic with normal left ventricular (LV) systolic function; therefore, follow-up echocardiography in 6 to 12 months is the most appropriate management. Appropriate follow-up in patients with asymptomatic severe aortic stenosis includes a clinical evaluation and echocardiography every 6 to 12 months. Patients should also be educated to identify and report possible aortic stenosis–related symptoms, such as dyspnea, reduced exercise tolerance, exertional chest pain, lightheadedness, and syncope, before scheduled follow-up.

Balloon valvuloplasty, although important in the treatment of the pediatric patient with severe aortic stenosis, has a more limited role in adults owing primarily to its limited efficacy and the high rate of complications associated with the procedure. Additionally, this patient is asymptomatic, so there is no indication for intervention at present.

Surgical aortic valve replacement is indicated for symptomatic patients with severe aortic stenosis, asymptomatic patients with severe aortic stenosis and LV systolic dysfunction (LV ejection fraction <50%), and patients with severe aortic stenosis who are undergoing coronary artery bypass graft or surgery on the aorta or other heart valves. This patient is asymptomatic with normal LV systolic function, and he does not have any other cardiac procedures planned.

Transcatheter aortic valve replacement (TAVR) is indicated for patients with symptomatic severe aortic stenosis who are considered unsuitable for conventional surgery because of severe comorbidities. Currently, TAVR should not be performed in patients with intermediate or low surgical risk, and no therapeutic intervention is currently indicated in this asymptomatic patient.