Aortic Regurgitation

A 48-year-old woman who reports mild fatigue but no dyspnea, chest pain, or palpitation is found to have a diastolic murmur. Doppler color-flow echocardiography shows a bicuspid aortic valve with an eccentric jet of aortic regurgitation by color-flow imaging. The left ventricle is moderately enlarged, with an end-diastolic diameter of 66 mm (or 39 mm per square meter of body-surface area) and an end-systolic diameter of 46 mm (or 27 mm per square meter); the ejection fraction is 51 percent, and the ascending aorta is enlarged, at 48 mm. How should this patient be treated?