Contemporaneous management of valvular heart disease and aortopathy in aircrew

Abstract

Valvular heart disease (VHD) is highly relevant in the aircrew population as it may limit appropriate augmentation of cardiac output in high-performance flying and predispose to arrhythmia. Aircrew with VHD require careful long-term follow-up to ensure that they can fly if it is safe and appropriate for them to do so. Anything greater than mild stenotic valve disease and/or moderate or greater regurgitation is usually associated with flight restrictions. Associated features of arrhythmia, systolic dysfunction, thromboembolism and chamber dilatation indicate additional risk and will usually require more stringent restrictions. The use of appropriate cardiac imaging, along with routine ambulatory cardiac monitoring, is mandatory in aircrew with VHD.Aortopathy in aircrew may be found in isolation or, more commonly, associated with bicuspid aortic valve disease. Progression rates are unpredictable, but as the diameter of the vessel increases, the associated risk of dissection also increases. Restrictions on aircrew duties, particularly in the context of high-performance or solo flying, are usually required in those with progressive dilation of the aorta.

Non-coronary cardiac surgery and percutaneous cardiology procedures in aircrew

“…Aircrew flying high-performance aircraft must be able to maintain cardiac output even under high preload conditions (with sustained acceleration (+G z )), and any chronotropic or inotropic deficit secondary to valvular disease is usually poorly tolerated. 7 In addition to the direct effect of valvular heart disease, additional factors affecting suitability for flying duties include the risk of LV impairment, increased arrhythmia risk and the potential need for anticoagulation. In military aviation, anticoagulation is often disqualifying, however, many civil regulations have become less strict in recent years, despite controversy regarding both bleeding and thrombosis risk.…”

Meta-Analysis of the Disease Spectrum of Hospitalized Crew-Members

“…Getting hold by diseases and being detained in hospital would stop them from working in the air. Once there is a problem with the health of crew-members, the aeronautical training and duty will be seriously interrupted [4] . Therefore, the support for health management of crew-members is profoundly crucial.…”

An introduction to aviation cardiology

“…This manuscript describes the current medical regulatory framework for aircrew; aircrew roles in the civil and military aviation profession; the types of aircraft and aviation environment that must be understood when managing aircrew with CVD; the regulatory bodies involved in aircrew licensing and the risk assessment processes that are used in aviation medicine to determine the suitability of aircrew to fly with medical (and specifically cardiovascular) disease; and the ethical, occupational and clinical tensions that exist when managing patients with CVD who are also professional aircrew. It serves as an introduction to the subsequent papers on risk assessment of aircrew, 10 screening of aircrew 11 and specific articles that address coronary artery disease (both pre- and post-intervention), 12 13 electrical abnormalities of the heart, 14 valvular disease, 15 heart muscle disease, 16 congenital heart disease 17 and cardiac intervention 18 in aircrew. This article does not address cabin crew or passengers.…”