Heart Valve

Guidance for medical examiners when assessing a patient for either a general topic or condition – Heart Valve.

Aeromedical implications

Effect of aviation on condition

  • Increased cardiac workload during stressful phases of flight
  • Increased cardiac workload during high ‘g’ flight

Effect of condition on aviation

  • Overt incapacitation from cardiac arrhythmia or cardiac arrest
  • Overt incapacitation from ‘g’ induced loss of consciousness
  • Subtle incapacitation due to impaired exercise tolerance

Effect of treatment on aviation

  • Risks of bleeding with acute incapacitation due to anticoagulation (if applicable)

Approach to medical certification

Based on the condition

  • Acceptable cardiac output
  • Rate of progression of valvulopathy
  • Acceptable valvular parameters (areas and pressures)

Based on treatment

  • Outcome of surgery (if applicable)
  • Acceptable and effective anticoagulation (if applicable)
  • Acceptable management of cardiovascular risk

Demonstrated stability

  • Absence of symptoms
  • Satisfactory exercise tolerance
  • Absence of significant cardiac arrhythmia

Risk assessment protocol - information required

New cases

A report from the Specialist monitoring the applicant’s Heart Valve
surgery/condition.

  • Clinical status
    • progress, symptoms and details of any changes
    • adverse sequelae (arrhythmias, ventricular function etc.)
    • compliance with and stability of antiplatelet and anticoagulant medication (if applicable)
    • estimate of cardiovascular risk
  • Investigations conducted
    • ECG
    • Exercise stress test
    • Echocardiogram (required annually)
  • Management
    • treatment
    • side-effects
    • monitoring
  • Follow-up plan.

Renewal - specialist report

  • Clinical status
    • progress, symptoms and details of any changes
    • adverse sequelae (arrhythmias, ventricular function etc.)
    • compliance with and stability of antiplatelet and anticoagulant medication (if applicable)
    • estimate of cardiovascular risk
  • Investigations conducted
    • ECG
    • Exercise Stress Test
    • Echocardiogram (required annually)
  • Management
    • treatment
    • side-effects
    • monitoring
  • Follow-up plan.

Indicative outcomes

  • In most cases applicants will be subject to 12 month audit / review long term
  • In cases where surgery is required, assessments will be no sooner than six months post-surgery with a new medical application to the DAME
  • Anticoagulation will require additional conditions to be placed on the medical certificate. See Anticoagulation advice. Certificates may be subject to long term multi-crew restriction
  • Co-existing coronary artery disease will be subject to additional assessment
  • To certify there must not be
    • symptoms of reduced cardiac output
    • significant rhythm disturbance
    • significant (ungrafted) coronary artery disease
    • any history of thromboembolism.

Favourable

  • Good valve function
  • Absence of complications 

Unfavourable

  • Clexane (acceptable during initial combination treatment with Warfarin but unfavourable for long term treatment)
  • New Anticoagulants eg Rivaroxaban, Dabigatran, Ximelagatran, and Apixaban (see anticoagulant link)

Pilot and controller information

  • The pilot or controller should inform their DAME on diagnosis of the condition, and must not exercise the privileges of the medical certificate until cleared by CASA
  • Anticoagulation may or may not be required depending on the type of replacement heart valve. Applicants should discuss their treatment options with their specialist. See Anticoagulation advice.

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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