American Board of Internal Medicine (ABIM) Certification Practice Exam

When is surgery recommended for aortic root repair or replacement in patients with a bicuspid aortic valve?

1. When the aortic root diameter is greater than 6.0 cm

2. When the aortic root diameter is greater than 5.0 cm

3. When the aortic root diameter is greater than 5.5 cm

4. When symptoms begin to develop

The correct answer is: When the aortic root diameter is greater than 5.5 cm

Surgery for aortic root repair or replacement in patients with a bicuspid aortic valve is recommended when the aortic root diameter exceeds 5.5 cm. This threshold is based on guidelines that aim to prevent complications such as aortic dissection or rupture, which are more likely to occur as the diameter increases. The 5.5 cm measurement is considered the standard cutoff for surgical intervention due to the heightened risk of these serious complications at this size. In patients with a bicuspid aortic valve, the aortic root tends to dilate more rapidly than in individuals with a normal trileaflet valve, which necessitates closer monitoring and intervention at lower thresholds. While other factors, such as the presence of symptoms and other anatomical considerations, can influence the decision to operate, the primary recommendation focuses on preventive measures when the aortic root reaches this critical diameter. Therefore, continuing to monitor patients with a smaller aortic root diameter or those who are asymptomatic is appropriate and aligns with current clinical practice. This approach aims to provide a balance between reducing surgical risk and preventing potentially life-threatening complications.