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Heart valve replacement
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Heart valve replacement

I was born with a bicuspid aortic valve which now had mild calcific aortic valve stenosis.  Both my aortic valve and mitral valve have moderate regurgitation.  The pulmonary valve and tricuspid valve have mild regurgitation.  I am told I have severe left atrial enlargement.  Lambl's excrescences are on the aortic valve.  My ECG shows marked sinus bradycardia. I am told that I will need a valve replacement within five years.  My question is:  how do you determine when I am ready for a valve replacement?  If I am having symptoms of shortness of breath, fatique, dizzy spells, wouldn't it be better to do the valve replacement sooner, rather than later, while I am still as healthy as possible?  I do not want to go on drugs.  When is it reasonable for me to expect to have surgery?  I have always been healthy, active and take very good care of myself.

Also, is is possible for a valve repair to be done, instead of a valve replacement?

Mary
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There are different parameters that we used to make decisions regarding valvular surgery, however, the development of symptoms, for either the mitral or the aortic valve, is an indications that surgery should be done soon.  It is, however, sometimes difficult to be certain that the symptoms are related to the valve.   Stress echocardiography or TEE can be helpful in making these distinctions.  The fact that you left atrium is severely enlarged makes me concerned about the mitral valve, namely its severity.  It is possible that the regular echocardiography, or the exam aren't accurate in your case.  I would recommend stress testing or a TEE to further quantify the degree of mitral insufficiency in your case.  Mitral valves can generally be repaired.  The bicuspid valve usually is very difficult to repair and generally needs a replacement.  
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