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Guide for Aviation Medical Examiners

Special Issuances
Third-Class AME Assisted - Valve Replacement

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

This AASI is presently restricted to the issue of a third-class airman medical certificate. First- and second-class applicants must be deferred to the FAA.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR ยง 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

  • An Authorization granted by the FAA;
  • A current status report performed within the past 90 days in accordance with the CHD Protocol;
  • A current 2D echocardiogram performed within 90 days; and
  • For Mechanical Heart Values - A minimum of monthly International Normalized Ratio (INR) results for the immediate prior six months.

The Examiner must defer medical certification to AMCD or Region if:

  • The airman requires another valve procedure;
  • Evidence of perivalvular leaking via echocardiogram;
  • The post procedure valve area is less than 1.0 cm2;
  • New onset arrhythmia such as of atrial fibrillation/flutter, ventricular bigeminy, ventricular tachycardia, Mobitz Type II or greater AV block, complete heart block, RBBB, LBBB or LVH;
  • More than 20% of INR values are less than 2.5 or greater than 3.5. In select cases of a Bileaflet (St. Jude) valve in the aortic position, INR values between 2.0 and 3.0 may be accepted (check with FAA);
  • The applicant reports any other disqualifying medical condition or undergoes therapy not previously reported; or
  • The applicant develops emboli, thrombosis, bleeding that required medical intervention, or any other cardiac condition previously not diagnosed or reported.

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