American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the operative approach of choice for patients with asymptomatic chronic severe mitral regurgitation?

1. Aortic valve replacement

2. Mitral valve repair

3. Coronary artery bypass grafting

4. Atrial septal defect closure

The correct answer is: Mitral valve repair

The choice of mitral valve repair as the operative approach for patients with asymptomatic chronic severe mitral regurgitation is based on several key factors. Mitral valve repair is preferred because it offers several benefits, including the preservation of the native valve structure, which often leads to better long-term outcomes compared with valve replacement. In cases of chronic severe mitral regurgitation, even in asymptomatic patients, there is a significant risk for ventricular dilation and eventually heart failure. Mitral valve repair can restore normal valve function and hemodynamics, reducing the risk of these complications. Furthermore, studies have shown that surgical intervention, particularly valve repair, can be performed safely in asymptomatic patients with evidence of left ventricular dysfunction or enlargement, as this can help prevent deterioration in ventricular function and improve overall prognosis. Mitral valve repair techniques also typically have lower rates of morbidity compared to replacement, as replacement may necessitate lifelong anticoagulation and carries a risk of prosthetic valve-related complications. Therefore, the focus on preserving the valve through repair in asymptomatic patients aligns with contemporary guidelines and surgical practices to optimize long-term outcomes. The other options listed, such as aortic valve replacement, coronary artery bypass grafting, and atrial septal defect closure, do