Negative impact of high-performance flights on aviators with mitral valve prolapse

BACKGROUND

While it appears not to affect healthy aviators' hearts, there are scarce data regarding the impact of high-performance flights on aviators with mitral valve prolapse (MVP).

METHODS

A retrospective, comparative cohort study of military aviators with MVP. Subjects were categorized to either high-performance (jet fighter) or low-performance (transport and helicopter) aviators. The primary outcomes were the rates of mitral interventions and of adverse cardiovascular events since being an aircrew candidate and up to the end of flying career. Additional outcomes were echocardiographic measurements and the cumulative proportion of mitral valve interventions over time.

RESULTS

Of 33 male aviators with MVP, 18 were high-performance aviators. On average, follow-up started at age 18.5 years and lasted 27.8 ± 10.1 years. Baseline characteristics were similar between the study groups. Aviators of high-performance aircraft had increased rates of mitral valve surgery (33 % vs. 0, p = 0.021), MVP-related complications (39 % vs. 6.7 %, p = 0.046), and a higher incidence of mitral valve repair over time (p = 0.02). High-performance flight was associated with increased intraventricular septum thickness (IVS, 9.7 mm vs 8.9 mm, p = 0.015) and IVS index (p = 0.026) at the last echocardiographic assessment. High-performance aviators tended to develop worsening severity of mitral regurgitation.

CONCLUSIONS

High-performance flight may be associated with an increased risk for valvular deterioration and need for mitral surgery in aviators with MVP.

Natural history of mitral valve prolapse in military aircrew

OBJECTIVE

Mitral valve prolapse (MVP) is a common cardiac abnormality whose natural history differs among various patient populations. High-performance flight is associated with exposure to varying acceleration forces and strenuous isometric physical activity. The effect of the military flying environment on the natural history and progression of MVP is poorly defined.

METHODS

We evaluated a cohort which included all military aviators in the Israeli Air Force diagnosed with MVP. Medical records and echocardiographic studies of participants were reviewed for the development of clinical or echocardiographic complications.

RESULTS

The study population was comprised of 24 aviators, 14 of whom were high-performance aviators. Average follow-up was 23.5 years (total 563 person-years). Four aviators suffered from MVP-related complications including 2 cases of flail valve due to chordae rupture and 1 case each of newly diagnosed atrial fibrillation and infective endocarditis. Progression of asymptomatic mitral regurgitation was identified in 11 aviators.

CONCLUSIONS

Military aviators with MVP may be prone to serious medical complications. A detrimental effect of high-performance flight on patients with MVP is suggested.