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Guide for Aviation Medical Examiners

Decision Considerations
Disease Protocols - Valve Replacement

Applicants with tissue and mechanical valve replacement(s) are considered after the following:

  1. First- and second-class initial applicants are reviewed by the Federal Air Surgeon's cardiology panel and must have a 6-month recovery period to ensure stabilization before consideration;
  2. Copies of hospital/medical records pertaining to the valve replacement; include make, model, serial number and size, admission/discharge summaries, operative report, and pathology report;
  3. If applicable, a current evaluation from the attending physician regarding the use of Coumadin to confirm stability without complications, drug dose history and schedule, and International Normalized Ratio (INR) values (within acceptable range) accomplished at least monthly during the past 6-month period of observation;
  4. A current report from the treating physician regarding the status of the cardiac valve replacement. This report should address your general cardiovascular condition, any symptoms of valve or heart failure, any related abnormal physical findings, and must substantiate satisfactory recovery and cardiac function without evidence of embolic phenomena, significant arrhythmia, structural abnormality, or ischemic disease.
  5. A current 24-hour Holter monitor evaluation to include select representative tracings;
  6. Current M-mode, 2-dimensional echocardiogram with Doppler. Submit the video resulting from this study;
  7. A current maximal GXT - See GXT Protocol;
  8. If cardiac catheterization and coronary angiography have been performed, all reports and films must be submitted, if requested, for review by the agency. Copies should be made of all films as a safeguard against loss;
  9. Following heart valve replacement, first- and second-class certificate holders shall be followed at 6-month intervals with clinical status reports and at 12-month intervals with a CVE, standard ECG, and Doppler echocardiogram. Holter monitoring and GXT's may be required periodically if indicated clinically. For third-class certificate holders, the above followup testing will be required annually unless otherwise indicated.
  10. Single, Mechanical and Valvuloplasty - See AASI for Cardiac Valve Replacement;
  11. Multiple Heart Valve Replacement. Applicants who have received multiple heart valve replacements must be deferred, however, the AMCD may consider certification of all classes of applicants who have undergone a Ross procedure (pulmonic valve transplanted to the aortic position and pulmonic valve replaced by a bioprosthesis).

It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification. A medical release form may help in obtaining the necessary information.

All information shall be forwarded in one mailing to:

Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-313
Post Office Box 25082
Oklahoma City OK 73125-9914
Federal Aviation Administration
Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
6700 S MacArthur Blvd., Room B-13
Oklahoma City OK 73169

No consideration can be given for Authorization for Special Issuance of a Medical Certificate until all the required data has been received.

Use your full name on any reports or correspondence will aid us in locating your file.

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