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Enlarged aortic root and bicuspic aortic valve
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Enlarged aortic root and bicuspic aortic valve

I'm 56 yrs old with a bicuspid aortic valve, otherwise healthy.  I'm 6'0" and weigh 162 lbs.  My aortic root measure 3.8 cm in diameter and has been stable for a few years.  I'm treated with lisinopril to reduce aortic root stress.  My blood pressure is usually about 110 over 68.  No valve stenosis.  My cardiologist is watchful but otherwise not immediately concerned.  At what point should I be concerned about replacing the aortic root?  
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I am assuming that there is no stenosis and no regurgitation of the valve.  If that's the case, the Aortic root needs to be monitored, probably with yearly echo's or other modalities such as MRI or CT.  You basically want to postpone doing any surgery on the root as far as possible in case you develop aortic stenosis or aortic regurgitation so that both can be dealt with at the same time.  Of couse, once you go pass 6 cm in the root the risk of rupture or dissection increases and this is why we never delay surgery at that point.  
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Thanks very much for the information.  I'm currently taking 20 mg of lisinopril to reduce stress on the aortic root.  My blood pressure is usually about 110 over 68.  My internist has suggested switching from lisinopril to losartan since a New England Journal of Medicine article (June 26, 2008) reported better management of root diameter with an ARB.  My cardiologist is less willing to make the switch since my root diameter has been stable at 3.8 cm for a few years.  I'd appreciate your thoughts on the benefits of switching to losartan.  
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A related discussion, 5.0 cm surgical threshold for Aortic Root Aneurysms was started.
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