Here's the bottom line in a nutshell:
In general, patients with mild-to-moderate valvular dysfunction and normal left ventricular (LV) dimensions and function should be monitored by echocardiography at regular intervals. Aortic valve replacement is indicated for severe valvular dysfunction, symptomatic patients, and/or those patients with evidence of abnormal LV dimensions and function (Table). Because many of these patients will require cardiac surgery during their lifetime, early referral to a surgeon with experience in aortic valve surgery is recommended.
Basically, once someone is diagnosed with BAV, then "early referral to a surgeon with experience in aortic valve surgery is recommended."
In my case the good news is that I believe the the disease was diagnosed before it has progressed too far but only because I elected to seek out a surgeon on my own. My "numbers" are borderline severe: valve area 1.3 cm2 (technically "moderate" but "severe" - when adjusted for my body size - valve area index = .55); aortic dilation of 4.3 cm - which is in the range that can trigger surgery:
Aortic dilation should be carefully monitored by echocardiography21 and aortic root replacement recommended more aggressively for patients with BAV24 with aortic dilation (ie, 4 to 5 cm) than for those of patients with tricuspid valve (ie, 5 to 6 cm).
So, there's the scoop. I'll have my CT angio chest and see the surgeon again on January 6. To me it looks like all that is left to be done is to the set the date for surgery and select the valve prosthesis. I'll have to ask the surgeon what his plan is to deal with the aortic aneurysm.