American Board of Internal Medicine (ABIM) Certification Practice Exam

In diagnosing severe mitral stenosis, which of the following values for MVA is considered critical?

1. MVA >1.5 cm2

2. MVA ≤1.5 cm2

3. MVA =2.0 cm2

4. MVA ≤2.5 cm2

The correct answer is: MVA ≤1.5 cm2

In the context of diagnosing severe mitral stenosis, a mitral valve area (MVA) that is less than or equal to 1.5 cm² is considered critical. This threshold indicates significant obstruction to blood flow across the mitral valve, which can lead to a range of complications, including pulmonary congestion and heart failure. Mitral stenosis leads to pressure overload of the left atrium, and as the MVA decreases, the severity of the stenosis increases. The measurement of MVA is crucial for evaluating the severity of the condition and determining the appropriate management strategies. An MVA of 1.5 cm² or less typically signifies that intervention, such as mitral valve repair or replacement, may be necessary to alleviate symptoms and reduce the risk of complications. Values greater than 1.5 cm² suggest milder forms of mitral stenosis, where management may differ significantly, indicating that those patients might not require immediate intervention. In contrast, options that reference higher values, such as an MVA of 2.0 cm² or 2.5 cm², do not reflect critical stenosis and represent less severe conditions that would not warrant the same level of clinical concern.