The decision to intervene on a bicuspid aortic valve has to do with the degree of stenosis. We are typically trained to look at the pressure gradient across the valve, which isn’t related here. Usually, a mean gradient of 50-60mmHg would lead to an intervention, as that meets the criteria for “severe stenosis.” The type of intervention can vary. Some patients are a good candidate for balloon valvuloplasty which is a catheterization based procedure and not a surgery. Some are better fits for a surgical repair. A lot has to do with the nature of the valve.
A stress test is reasonable, and it is not surprising not to have symptoms. Symptoms do not often drive the decision making to intervene. It is the findings of increasing stenosis or hypertrophy of the left ventricle.
Thank you Dr. John Breinholt