American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended approach for tricuspid regurgitation when the anatomical conditions are favorable?

1. Tricuspid valve replacement (mechanical)

2. Tricuspid valve replacement (bioprosthetic)

3. Tricuspid valve repair

4. Medical management only

The correct answer is: Tricuspid valve repair

The recommended approach for tricuspid regurgitation when the anatomical conditions are favorable is tricuspid valve repair. This is primarily because tricuspid valve repair is associated with lower morbidity and mortality compared to valve replacement options. When the anatomical structure, such as the valve leaflets and supporting structures, is suitable for repair, techniques such as anuloplasty can significantly improve valve function, restore normal hemodynamics, and enhance the patient's quality of life. Repair tends to preserve the native valve and is beneficial in maintaining normal valve function without the complications associated with prosthetic valves, such as the need for long-term anticoagulation and risk of valve-related thrombosis. Additionally, repair techniques have shown excellent long-term results, making it the preferred option under favorable conditions. Other approaches like valve replacement (either mechanical or bioprosthetic) involve greater risk and complications, according to studies. Thus, in suitable anatomical cases, opting for repair maximizes patient outcomes while minimizing risks associated with more invasive alternatives. Medical management may help to alleviate symptoms, but it does not address the underlying structural problem, making repair the more favorable option in anatomical cases conducive to such an intervention.