American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be the threshold for reassessment of ascending aortic diameter via echocardiography in asymptomatic patients with bicuspid aortic valves?

1. 4.5 cm

2. 5.0 cm

3. 4.0 cm

4. 5.5 cm

The correct answer is: 4.0 cm

In asymptomatic patients with bicuspid aortic valves, the recommendations for reassessment of ascending aortic diameter via echocardiography usually emphasize a threshold of 4.0 cm. This threshold is based on the increased risk of aortic dilation and potential complications associated with the presence of a bicuspid aortic valve. Monitoring at 4.0 cm is critical as it allows for early intervention before the aortic diameter reaches levels that significantly raise the likelihood of adverse events, such as dissection or rupture. It's particularly important in this patient population, as they tend to have an increased likelihood of aortic dilation compared to those with trileaflet aortic valves. In addition, studies suggest that while aortic intervention is often considered at larger diameters, the 4.0 cm threshold serves as a proactive measure to guide closer surveillance and manage the condition effectively. This approach enables healthcare providers to monitor the progression and determine the right time for surgical intervention, ensuring better outcomes for patients with this structural heart condition.