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Aortic Bicuspid Valve in Flight Crew:  Case-Reports and Aeromedical Fitness

Aortic Bicuspid Valve in Flight Crew:  Case-Reports and Aeromedical Fitness. Med Maj DELRUE Centre for Aviation Medicine Brussels Belgium. Bicuspid Aortic Valve. Most common cardiac defect Not only the valve but the whole aortic root 1 to 2 % of the population Sex ratio 4 men/1 woman.

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Aortic Bicuspid Valve in Flight Crew:  Case-Reports and Aeromedical Fitness

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  1. Aortic Bicuspid Valve in Flight Crew:  Case-Reports andAeromedical Fitness Med Maj DELRUE Centre for Aviation Medicine Brussels Belgium

  2. Bicuspid Aortic Valve Most common cardiac defect Not only the valve but the whole aortic root 1 to 2 % of the population Sex ratio 4 men/1 woman

  3. Normal Aortic Valvesystole diastole

  4. Normal Aortic Valvesystole diastole

  5. Bicuspid Aortic Valve

  6. Tricuspid Bicuspid

  7. Pathogenesis Defect fibrillin-1 Hereditary? : autosomal dominant with reduce penetrance screening of first degree relatives

  8. Type of Bicuspid Aortic Valve Prof Sievers (Luebeck Germany)

  9. Type of Bicuspid Aortic Valve Prof Sievers (Luebeck Germany)

  10. Type 1 L/R A B

  11. RISKS of Bicuspid Ao Valve Serious complications 33 % Responsible for more complications and death than all others cardiac malformations Valvular stenosis Regurgitation Endocarditis Dilation and dissection Aortic Root (X9)

  12. Associations 50 % of young people with normal bicuspid functioning valve have aortic dilation. coarctation of the aorta (50-80%) septum anomalies Coronary anomalies More cerebral aneurysms ?

  13. Aortic Dilation and Bicuspid Aortic Valve Ascending Aorta : D(mm) =31+0.16* age (years) Aneurysm 40 mm 20-year-old 45 mm 40 year-old 50 mm 60 year-old

  14. Follow-up Annual transthoracic of transesophageal echocardiography (valve function) Annual MRI (or CT angiography/aortic protocol) if >40 mm or above age-related normal range (6 months if rapid progression)

  15. Ct scan

  16. Surgery Repair No valvular indication a. max diam >= 50 mm b. rapid growth progession of >= 0.5 cm/year b. maximum aortic cross-sectional area/body height >= 10 cm2/m

  17. Surgery Repair If valvular indication Max diameter >=45 mm Max aortic cross-sectional area/body >= 8-9 cm2/m More Attention if pregnancy, sudden death or aortic dissection in 1st degree relative

  18. Screening • Auscultation +- 60 % Aortic regurgitation • 16% of severe not diagnostiqued

  19. Screening? • 2278 asymptomatic competitive Italian athletes (Age 31+- 11 years) : echocardiography • 58 (2,5%) BAV • Only 9 normal function • 45 Aortic regurgitation (14 mild, 25 moderate, 8 severe) • Stenosis 2 • Aortic root > nl • 15 disqualified for sport

  20. Case Report 1 Jan 2013 Military Pilot applicant Male 18 year Sclerosis Aortic Valve Aortic Bicuspid valve Aortic Root dilatation 37 mm (nl 33.8 mm) Military Pilot Applicants : systematic echography UNFIT

  21. Classe 1 civilian ? EASA rules (European Aviation Safety Agency) May be assessed as fit if no other cardiac or aortic abnomaly Here : proposal FIT with annual cardiologic review (outcome?) licensing autority

  22. Case Report 2 Military ATC male 53 years 2002 : aortic murmur detected : echography : Bicuspid Valve + calcifications no dilation aorta + Aortic regurgitation ¼ Follow up every year echography 2011 : dyspnea (stairs) progression of sclerosis valve (0.9 cm2) Aortic replacement Ross procedure (pulmonary autograft) 6 months unfit FIT with Annual cardiologic review

  23. Case report 3 41 year old helicopter pilot Federal Police 1990 : military heli applicants no echography 2001 : Aortic murmur : echography Aortic Bicuspid Valve + dilation Ao Root 41 mm Aorta Regurgitation 2/4 Fit with 6 months cardiologic review 2005 Aortic Root : 46 mm CT scan 2010 48.5 mm Classe 1 OML(multicrew) SIC Cardiologic evaluation 6 months 2011 51 mm unfit Classe 1

  24. Bentall • video

  25. Read More • Etz, Misfefd and al. Indication for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia. Cardiol Res Pract 2012; 313879. • Fedak, Verma and Al. Clinical and Pathophysiological Implications of a Bicuspid Aortic Valve. Circulation 2002; 106: 900-904.

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