Ascending Aortic Aneurysm and Normal function Bicuspid Aortic Valve

Dear Sir/Madam,

I am writing to you for an expert opinion regarding my mother's case which is as follows.

61 years old with an asymptomatic 5 cm ascending aortic aneurysm and a
bicuspid aortic valve, no arch involvment.

This was an incidental finding 3 years ago whilst having an angiogram for chest pain which
was found to be non-cardiac and has not recurred since. On discovering this 3 years ago it
measured 4.7 cm.

A surveillence scan last week shows an increase in size to 5 .0 cm. She has smoked 10 cpd for 40 years and has controlled HTN. Recent ECHO shows minimal AR and LVF of 60%.

The questions I would like to ask are :
1. would you recommed a repair at this stage in light of her being asymptomatic or a wait and watch policy
2. would you recommend replacing the bicuspid aortic valve seeing as it is functoning well
3. Is she likely to require an aortic valve replacement in the future in your experience

I am very grateful for your online assistance and await your response

Yours Sincerely

Mr Nicholas Stylianides MBChB MRCS UK