8 yr old nonverbal autistic child + bicuspid aortic valve + now also diagnosis with 3.15 cm dilated ascending aorta. when to do surgery?

Complicated question: Timing of aortic root replacement is complex in childhood. Factors include the z-score of the aortic root diameter (which requires knowledge of body surface area), the rate of growth of the aorta, the function of the aortic valve, and the underlying cause. At 3.15 cm, it is unlikely that surgery is indicated at this time. Surveillance, typically by echocardiogram, should be performed regularly.