American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended aortic diameter threshold for repair in patients with a bicuspid aortic valve?

1. Greater than 4.0 cm

2. Greater than 5.0 cm with increased risk

3. Only when symptomatic

4. Greater than 5.5 cm in all cases

The correct answer is: Greater than 5.0 cm with increased risk

The recommended aortic diameter threshold for repair in patients with a bicuspid aortic valve is greater than 5.0 cm with increased risk. Bicuspid aortic valve disease is associated with a higher incidence of aortic dilation and dissection when compared to the general population with trileaflet aortic valves. In patients with a bicuspid aortic valve, the aorta tends to enlarge more rapidly, and aortic surgery is generally indicated at a smaller diameter threshold due to this increased risk of complications. While guidelines typically suggest a threshold of 5.5 cm for the general population, in patients with a bicuspid valve, the greater risk necessitates intervention often at 5.0 cm or less, particularly if there are other risk factors such as a family history of aortic dissection or rapid aortic growth over time. This approach helps to prevent potentially life-threatening incidents, such as aortic dissection, which can occur even at diameters lower than what is typically indicated for repair in individuals with a normal aortic valve. Therefore, monitoring and potentially opting for surgical intervention at the 5.0 cm threshold reflects the need for a proactive strategy in managing the risks associated with bicuspid aortic