American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred treatment for severe symptomatic mitral stenosis?

1. Mitral valve replacement

2. Percutaneous balloon mitral valvuloplasty

3. Medical management

4. Surgical intervention

The correct answer is: Percutaneous balloon mitral valvuloplasty

The preferred treatment for severe symptomatic mitral stenosis, particularly in patients who are appropriate candidates, is percutaneous balloon mitral valvuloplasty. This procedure is minimally invasive and involves the insertion of a balloon catheter to dilate the narrowed mitral valve, effectively alleviating symptoms of obstruction caused by the stenosis. It offers significant benefits, such as rapid symptom relief, shorter recovery times, and a reduced risk of complications compared to surgical options. Percutaneous balloon mitral valvuloplasty is often the first-line treatment for patients with favorable valve morphology, especially those who are symptomatic and have not yet developed significant left atrial enlargement or other surgical risks. The procedure can improve the quality of life and functional capacity of patients, as well as decrease the incidence of complications associated with mitral stenosis, like pulmonary hypertension and atrial fibrillation. In contrast, mitral valve replacement is typically reserved for cases where balloon valvuloplasty is not feasible or in patients who have significant valve deformities. Medical management, while useful for symptom control and management of comorbid conditions, does not address the underlying structural problem of the stenotic valve. Surgical intervention may also be appropriate in specific circumstances, but it usually necessitates a more invasive approach