American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition indicates the need for mitral valve surgery?

1. Asymptomatic mild mitral regurgitation

2. Symptomatic severe mitral regurgitation with an ejection fraction greater than 30%

3. Severe mitral valve stenosis

4. Asymptomatic individuals with an ejection fraction below 30%

The correct answer is: Symptomatic severe mitral regurgitation with an ejection fraction greater than 30%

The indication for mitral valve surgery primarily revolves around the patient's symptoms and the severity of the mitral valve condition. In the case of symptomatic severe mitral regurgitation, the need for surgical intervention becomes significant, especially when the ejection fraction remains above a certain threshold. Severe mitral regurgitation can lead to heart failure and other complications if not addressed. When the patient presents with symptoms—such as dyspnea, fatigue, or palpitations—it signals that the heart is struggling to cope with the volume overload due to the regurgitation. While an ejection fraction above 30% may indicate that the heart still has some reserve function, it doesn't mitigate the risks associated with untreated severe mitral regurgitation. Surgical intervention at this stage can prevent further decline in the patient's condition, improve quality of life, and enhance overall survival rates. In contrast, asymptomatic mild mitral regurgitation does not typically warrant surgery since it usually has a benign course and does not present immediate risks. Severe mitral valve stenosis requires surgery, but it doesn't necessarily correlate with the same urgency as symptomatic regurgitation in terms of immediate surgical intervention without further evaluation. Lastly, asymptomatic individuals with a low ejection fraction may not necess