Military aviators with mitral valve prolapse: Long-term follow-up and aeromedical endpoints

Introduction: Mitral valve prolapse (MVP) is a disqualifying condition for USAF aviators. Trained USAF aviators, and in recent years flying training applicants, may be granted waiver for initial or continued flying duties following extensive, periodic evaluation. This study examines the usefulness of the various tests performed in that evaluation process and provides long-term follow-up from 404 USAF flyers with MVP. Methods: We retrospectively reviewed 2-dimensional echocardiography, Holter monitoring, treadmill exercise, thallium imaging, coronary fluoroscopy, cardiac catheterization, and centrifuge testing results from 404 military aviators evaluated at the Aeromedical Consultation Service between 1 January 1972 and 31 October 1993. Follow-up was achieved through questionnaires (91%) and death certificates, etc. Results: Mean follow-up was 8.6 yr (range 1-21 yr). Age at study entry was 21 to 64 yr (mean = 36 yr). The occurrence rate for suddenly incapacitating events (sudden cardiac death, syncope, pre-syncope, and cerebral ischemic episodes) was 0.32%/yr. Conclusions: Echocardiographic MVP in military aviators is associated with a low but statistically increased prevalence of "incapacitating" aeromedical events. Univariate predictors of adverse outcome included study entry with an enlarged left ventricle or left atrium, cardiovascular symptoms or findings, or MVP with thickened leaflets. Evaluation of coronary artery disease (CAD) in this population, absent specific indicators of CAD risk, is not indicated.