ITE Valvular Heart Disease Management 3

Question 1

A 65-year-old man with bicuspid aortic valve has severe AR with LVEF 55% and LVESD 52 mm but no symptoms. What is the most appropriate management?

Accepted Answer

Surgical aortic valve replacement

Answer

In severe AR, surgery is indicated when LVESD ≥50 mm (Class IIa) or ≥55 mm (Class I) even in asymptomatic patients to prevent irreversible LV dysfunction.

Question 2

Which echocardiographic parameter is most useful for determining surgical timing in asymptomatic chronic severe mitral regurgitation?

Accepted Answer

Left ventricular end-systolic diameter (LVESD)

Answer

LVESD ≥40-45 mm in severe chronic MR is the key echocardiographic threshold that prompts surgical intervention even in asymptomatic patients.

Question 3

A 70-year-old woman with known moderate aortic stenosis presents with new-onset syncope. Her echo shows AVA 0.85 cm² and mean gradient 48 mmHg. What is the most appropriate next step?

Accepted Answer

Aortic valve replacement

Answer

Syncope is one of the classic triad of symptoms in severe AS (along with angina and HF), and its onset marks a poor prognosis with ~3-year median survival if untreated—AVR is indicated.

Question 4

Which of the following is an absolute contraindication to percutaneous mitral balloon commissurotomy (PMBC)?

Accepted Answer

Left atrial thrombus

Answer

Left atrial thrombus is an absolute contraindication to PMBC because balloon inflation risks thrombus embolization and stroke.

Question 5

An 80-year-old man with severe AS is deemed high surgical risk (STS score 8%). He has no contraindications to TAVR. What is the recommended approach?

Accepted Answer

Transcatheter aortic valve replacement (TAVR)

Answer

TAVR is recommended for symptomatic severe AS in patients at high or prohibitive surgical risk (STS ≥8% or institutional agreement on high risk).

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Valvular Heart Disease Management 3