MRCP-0032

A 24-year-old male is admitted with worsening shortness of breath with signs of left ventricular failure. He has a known genetic condition. On examination, there is an ejection systolic murmur loudest over the aortic area radiating to the carotids, bibasal crepitations and pitting oedema to the knees bilaterally. On closer inspection of the patient, you note a wide vermillion border, small spaced teeth and a flat nasal bridge. The patient also has a disinhibited friendly demeanour. What is the likely precipitating valvular issue?