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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 � 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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