This patient with moderate aortic regurgitation should be reassessed clinically in 1 year. Patients with moderate aortic regurgitation should be evaluated on a yearly basis and echocardiography performed every 1 to 2 years.

Aortic valve replacement is indicated for symptomatic patients with chronic severe aortic regurgitation irrespective of left ventricular (LV) systolic function, asymptomatic patients with chronic severe aortic regurgitation and LV systolic dysfunction (LV ejection fraction ≤50%), and patients with chronic severe aortic regurgitation undergoing coronary artery bypass graft (CABG) or surgery on the aorta or other heart valves. This patient is not a candidate for aortic valve replacement.

Endocarditis prophylaxis is not recommended for patients with bicuspid aortic valves in the absence of another specific indication such as a prior episode of infective endocarditis, previous valve replacement, prior cardiac transplantation with valvulopathy, and certain forms of complex congenital heart disease.

Medical therapy for chronic aortic regurgitation is limited. ACE inhibitors or angiotensin receptor blockers may be used in patients with chronic severe aortic regurgitation and heart failure as well as in patients with aortic regurgitation and concomitant hypertension, but these agents, as well as dihydropyridine calcium channel blockers, have not been shown to delay surgery in asymptomatic patients without hypertension. There is no established benefit in medical therapy for this patient with moderate aortic regurgitation without other specific indications for treatment.