American Board of Internal Medicine (ABIM) Certification Practice Exam

When is mitral valve replacement indicated in patients with severe mitral stenosis?

1. When symptoms improve

2. When percutaneous balloon mitral valvuloplasty is available

3. When percutaneous balloon mitral valvuloplasty is unavailable or contraindicated

4. When the patient is asymptomatic

The correct answer is: When percutaneous balloon mitral valvuloplasty is unavailable or contraindicated

Mitral valve replacement is indicated in patients with severe mitral stenosis when percutaneous balloon mitral valvuloplasty is unavailable or contraindicated due to various factors. These may include factors such as the patient having extensive calcification of the mitral valve, the presence of other structural anomalies within the heart that would make balloon valvuloplasty less effective, or if the patient has significant comorbidities that would preclude the use of less invasive techniques. In cases of severe mitral stenosis, the condition can lead to significant hemodynamic changes and symptoms such as dyspnea, fatigue, and heart failure. If the less invasive approach of balloon valvuloplasty is not a viable option or carries too high a risk for an individual patient, then surgical replacement becomes the necessary intervention to restore normal valve function and improve the patient's quality of life. Expecting improvement of symptoms before considering mitral valve replacement does not align with the urgency that severe mitral stenosis can present, as the need for surgical intervention often arises specifically due to the sufficiency of symptoms and hemodynamic compromise. Additionally, while balloon valvuloplasty is a valuable treatment, it might not be appropriate for all patients, reinforcing the need for surgical intervention when