American Board of Internal Medicine (ABIM) Certification Practice Exam

What is considered a class IIa indication for mitral valve replacement?

1. Symptoms with low surgical success likelihood

2. LVEF >60% with an increase in LV size

3. Moderate mitral regurgitation at stable ejection fraction

4. Severe but asymptomatic mitral stenosis

The correct answer is: LVEF >60% with an increase in LV size

A class IIa indication for mitral valve replacement suggests that the procedure is reasonable and may be considered in certain clinical situations. The indication emphasizes that the potential benefit of the surgery outweighs the risks involved, although it is not categorized as essential or universally accepted. In the context provided, a left ventricular ejection fraction (LVEF) greater than 60% combined with an increase in left ventricular (LV) size signifies that there could be stress on the heart, likely due to the changing hemodynamics associated with significant mitral regurgitation. This scenario indicates that while the patient may not yet present with overt symptoms, the underlying alterations in heart structure and function warrant evaluation for surgical intervention to prevent progression to heart failure or other complications. As the LV size increases, it suggests that the heart is adapting to chronic volume overload, potentially leading to adverse outcomes if left untreated. Other choices represent different clinical scenarios that are either not meeting the criteria for valve replacement or are associated with higher surgical risk or less clear benefits from surgery. For example, having symptoms but a low likelihood of surgical success does not present a favorable indication for surgery. Moderate mitral regurgitation with stable ejection fraction may not necessitate immediate intervention if the patient remains asym