MITRAL VALVE PROLAPSE AND THE RISK FOR MITRAL VALVE INSUFFICIENCY IN COMBAT PILOTS

Background: Mitral Valve Prolapse is an abundant medical condition in the general population and most patients are asymptomatic. The incidence of sudden incapacitation due to sudden death, syncope or pre-syncope was 0.5% in a 8.6 years of follow up in the US air force. MVP is the leading risk factor for Mitral Valve Regurgitation (MVR) which is in term a major risk factor for sudden incapacitation during flight in high performance jets. We wish to describe two cases of combat pilots with a history of MVP who developed asymptomatic moderate to severe MVR and it's implications on waivers and follow up scheme for pilots with MVP. Case Reports: description a 58 year old pilot with a history of MVP was evaluated by Echocardiography due to a recent diagnosis of HTN. In the Echo there was an evidence for moderate to severe MVR with suspected rapture of the cordea tendinea. The second case is of a 26 year old pilot with a history of MVP which was diagnosed with asymptomatic moderate to severe MVR and rapture of the cordea tendinea on routine follow up Echo. Discussion: MVP is a risk factor for MVR. Pilots with MVP experiencing high G+ forces are at a higher risk to develop MVR which may cause complication leading to sudden incapacitation. Pilots with MVR are not approved for flying in high performance planes and pilots with MVP are approved only if there is no other structural defects including thickening of valve's leaf and enlargement of the heart chambers. The risk to develop a progressive though asymptomatic MVR in these pilot demand closer follow up which has to be modified according to the degree of insufficiency and pilot's age.