Bicuspid Aortic Valve

[blaise723]

Dear Doc,

I found out that I had BAV 3 years ago when I was 25. The cardiologist didn't really seemed concerned about it at all. Just told me to take antibiotics when having dental work done. No restrictions on physical activity, etc. Said they were barely able to detect a trace of regurgitation with the echocardiogram. After being explained how it was something I was born with, I didn't think twice about it. Last year, age 27, I began to think about it for some reason and started doing research online. All this did was freak me out on the issue so I decided to make an appointment to see him again. He told me again, that it was minute and they weren't even 100% able to make out my leaflets being bicupsid. He suggested, due to my concern, that we get a second opinion and sent me over to The Methodist Hospital for another echocardiogram and for their cardiologist to review the films. They too could barely make out that I had a bicuspid aortic valve, but confirmed the condition and noted that there was only a small trace of regurgitation.

So, with all that said, my medical certificate history: first one was a 3rd class back in 2005 at age 24 before knowing of the condition. Second one was a 2nd class last year before I had this follow up procedure done and felt the condition to be a non issue. I didn't report it during that medical, which I guess in retrospect I should have, but the feeling I got from the cardiologist with it being a minor birth defect left me not to think twice about it.

Currently, my 2nd class has expired and downgraded to a 3rd. I'm only a Comm SEL/Inst who's looking to get his CFI ticket. I want to get another 2nd class medical on the off chance of picking up work outside of flight instructing. So, I have a few questions. Am I illegal from flying further due to my condition being unreported up to this point even though it was only withheld in ignorance? When I go in for my 2nd class and report it what can I expect? I now have private health insurance and would have to pay out of pocket for further testing due to a high deductible. The previous tests were done under a company's insurance which made it affordable. If I have to obtain the previous films, do I have to pay out of pocket for that too? Basically, is this going to be a major hassle that will keep me on the ground for a few months and take a hit to my bank account?

Sorry for the long winded post and I appreciate any and all help in advance.

-Nick

[My Flight Surgeon]

Report it. Get copies of the cardiologist's notes and the echo report to send to the FAA if they ask for them. As long as you have no symptoms, this should not be an issue.

[blaise723]

Originally Posted by My Flight Surgeon

Report it. Get copies of the cardiologist's notes and the echo report to send to the FAA if they ask for them. As long as you have no symptoms, this should not be an issue.

I appreciate the quick response.

I'm happy to hear this shouldn't be an issue. This condition is listed on your website as a condition needing special issuance, though. Will this not be necessary based on the fact of there being no symptons?

Will obtaining the notes and report be something I'll have to pay for or something that is due to me at no charge as a patient if requested?

Thanks again.

[My Flight Surgeon]

They will want to review the records and will probably ask you to provide a follow-up report with ECHO every 1-2 years. You will still be able to get a medical though. Just provide exactly what the ask for.

[sopdan]

Though I'm not a doctor, I did stay at a Comfort Inn last night, and I have a SI for BAV.

It initially took about three months for them to issue the SI, and I have to send in the Dr.'s report along with echo results once a year (started as every 6 mos). I've held a 1st class medical the entire time (6+ years).

Mine has been followed since I was an infant, and my pressure gradient is usually in the high teens to low 20's. My SI states that the the AME can issue a medical as long as the gradient is less than 40 mm Hg, I assume that's probably standard.

Also, and Dr. Forred can verify, but I believe the AME cannot issue a medical the first time around for BAV, it has to be deferred to OKC. I've never paid extra for the medical records, although you may have to be very specific as to what you need, and explain why you need it.

As far as being legal to fly, you did not know about it before, so you can't be held responsible for it back then. However, you now know that you have a disqualifying medical condition, and thus must abide by the FARs. (ie. not fly until it's all sorted out with the feds)

It's basically just a huge pain in the ass, in my opinion.

[blaise723]

Originally Posted by sopdan

Also, and Dr. Forred can verify, but I believe the AME cannot issue a medical the first time around for BAV, it has to be deferred to OKC.

Doc, can you verify?

Originally Posted by sopdan

I've never paid extra for the medical records, although you may have to be very specific as to what you need, and explain why you need it.

Yes, I spoke with my cardiologist's office today and they're mailing me the reports free of charge.

Originally Posted by sopdan

As far as being legal to fly, you did not know about it before, so you can't be held responsible for it back then. However, you now know that you have a disqualifying medical condition, and thus must abide by the FARs. (ie. not fly until it's all sorted out with the feds)

It's basically just a huge pain in the ass, in my opinion.

I'm a little confused on this matter and hope the Doc can shine light on the subject as well.

61.53

(a) Operations that require a medical certificate. Except as provided for in paragraph (b) of this section, a person who holds a current medical certificate issued under part 67 of this chapter shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person:
(1) Knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation;

67.211

Cardiovascular standards for a second-class medical certificate are no established medical history or clinical diagnosis of any of the following:
(a) Myocardial infarction;
(b) Angina pectoris;
(c) Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant;
(d) Cardiac valve replacement;
(e) Permanent cardiac pacemaker implantation; or
(f) Heart replacement.

Now, technically I meet all those requirements but I'm wondering if this is what would disqualify me:

67.213

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—
(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

With only trace regurgitation, it's obvious that I don't have any condition described by (1) & (2).


So Doc, am I legal to fly?



sopdan, I appreciate your response and sharing your experience. It's always nice to hear from someone else who has the same condition.

[My Flight Surgeon]

You really need to get FAA approval. When you start to parse words with the feds, you never win.

They will ask for a follow-up every few years (which you should do anyway) and just have you send it to them. Not a big deal.

[blaise723]

Okay, I'll remain on the ground until I go for my new medical once the reports arrive. Again, I appreciate your input. Just don't want to end up in a situation where I can't fly for a few months as I wait to go through the special issuance process, but it is what it is.

Thanks.

-Nick

[My Flight Surgeon]

You could just mail the info to the FAA for their records. They will either send you a Special Issuance letter or one stating you are qualified and to report any change to them if it occurs. This way you will not be down while they make their decision.

[blaise723]

*UPDATE*

Been meaning to post about my medical. I was issued a 2nd class without any problems or restrictions. Brought the two echo reports with me per your advice. He also wanted a letter from my cardiologist stating that I have no limitations or restrictions. Had to go back the next day after having my Doc's office fax me a letter stating the aforementioned, at which point he then gave me the certificate. During the actual physical he listened to my heart and couldn't hear anything, so I assume with that and my reports which showed my condition to be minor, he was satisfied to grant me a certificate there without further FAA review. Just told me that he has to send in the reports and letter for my records. No mention of additional echos to be turned in, although I do intend on having another one done in 2 years (age 30) to keep monitoring.

A few questions:
Do I turn in any future echo reports voluntarily or only if the Doc or FAA request them?

Actually failed my urine sample the first time due to high protein levels. Nurse told me to drink a glass of water and it should pass after that. This was an AM physical. Does your urine contain higher levels of protein in the morning? I know it tends to be a darker yellow during my first void or two in the AM. Passed after drinking the water.

Far vision was 20/20. Near vision both eyes 20/20; left eye 20/20; right eye 20/30. With only my right eye I could barely get 3 letters correct on the bottom line. What is acceptable range before being told to wear glasses?


Thanks.

[My Flight Surgeon]

1) Only take the echo if the FAA requests it.
2) The protein cn be higher in the morning. Go to an afternoon appointment and do not exercise before going.
3) 20/40 will require glasses for near vision.

[blaise723]

Thanks for the quick response Doc.