American Board of Internal Medicine (ABIM) Certification Practice Exam

Annual evaluation in asymptomatic patients with bicuspid aortic valves should occur if the aortic diameter exceeds:

1. 4.0 cm

2. 4.5 cm

3. 5.0 cm

4. 5.5 cm

The correct answer is: 4.5 cm

Bicuspid aortic valve is a common congenital heart defect where the aortic valve has only two cusps instead of the usual three. Patients with this condition are at an increased risk for aortic dilation and subsequent aortic aneurysm. Regular monitoring of aortic size is crucial because the risk of rupture or dissection increases with larger diameters. The guideline for annual evaluation in asymptomatic patients with bicuspid aortic valves typically recommends initiating monitoring when the aortic root diameter exceeds 4.5 cm. At this size, the risk of adverse cardiovascular events is significant enough to warrant close observation, including potential surgery or other interventions if further dilation occurs. The recommendation aims to balance the risks associated with surgical intervention against the risks of waiting until the diameter reaches sizes associated with higher morbidity and mortality. This optimal threshold ensures that patients who may develop symptoms or complications are identified early, allowing for timely and appropriate management. Therefore, once the aortic diameter exceeds 4.5 cm, annual evaluations are central to monitoring and managing the progression of this potentially life-threatening complication associated with bicuspid aortic valves.