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Heart Valve
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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.
Disclaimer
The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer
