A 6-year-old girl presents to clinic for a routine physical examination. She reports mild dyspnea with vigorous play but denies chest pain, syncope, or orthopnea. Her parents note a family history of bicuspid aortic valve in a maternal uncle who required valve replacement at age 42. Vital signs are normal with SpO2 98% on room air. Cardiac examination reveals a systolic ejection murmur best heard at the right upper sternal border with normal S2 splitting. Transthoracic echocardiography shows a bicuspid aortic valve with mild stenosis (peak gradient 32 mmHg) and normal left ventricular function. Which of the following represents the most important long-term complication to monitor in this patient?

1. A)Progressive aortic stenosis with eventual need for valve replacement and/or aortic regurgitationGABARITO
2. B)Bacterial endocarditis due to abnormal valve morphology and turbulent flow
3. C)Left ventricular hypertrophy leading to diastolic dysfunction and heart failure
4. D)Ascending aortic dilatation with risk of aortic dissection
5. E)Atrial fibrillation from chronic hemodynamic burden on the left atrium