Aortic regurgitation

A 48-year-old woman who reports mild fatigue but no dyspnea, chest pain, or palpitation is found to have a diastolic cardiac murmur. The blood pressure is 140/50 mm Hg, and the pulses are bounding. Cardiac examination reveals decreased S1 and increased S2 intensity, with a grade 1/6 systolic murmur and a grade 3/6 diastolic murmur along the left sternal border. Doppler color-flow echocardiography shows a bicuspid aortic valve with an eccentric jet of aortic regurgitation. 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?