PDA

View Full Version : RBBB & Bicuspid Aortic


S3th17
22nd Jun 2006, 17:55
Hi

I'm pretty confused right now.. I recently found out that I have Complete Right Bundle Branch Block after doing an ECG. Looking up on JAR-FCL 3 page I saw that if I want to pass my JAR Class 1 medical I will have to do some additional tests (stress ECG and echocadiogram). I did those too and while the stress test was fine I found out from the echocardiogram that I also have Bicuspid Aortic Valve (lucky me). So does anyone has an ideea if I have any chance of passing the medical test (everything esle on the ecochardiogram was completly normal) because I live in Romania and it's pretty hard for me to go there unless I'm sure..

"Bicuspid Aortic Valve is acceptable without restriction if no other cardiac or aortic abnormality is demonstrated, but requires biannual review with echocardiography" - they say

Bendo
25th Jun 2006, 03:11
I am 33 with Australian ATPL, I have held a Class 1 medical since I was 18, and I have a bicuspid aortic valve (BAV).

You need to have a cardiologist check it out, as there are some other genetic defects that occur with the BAV. The worst one is a weaker arterial wall material, which allows your major vessels (particulalrly your aorta) to dilate. This causes aneuysms, which of course can kill you near-instantly.

If your valve needs replacement you will have restrictions put on your licence - in Australia you will be limited to "As or with a co-pilot"

I had my ascending aorta replaced 2 years ago this week, and I still have my own BAV. I am working as a Chief Flying Instructor and I will start with a small airline in September. Life's good! :ok:

redsnail
27th Jun 2006, 11:42
Bendo!! HTFAY?

Long time no post! :D

TinKicker
12th Jul 2006, 23:17
Hi S3th17,
I too am an Aussie (46) with an ATPL, held a class one medical since 18 (coincidentally when the Bicuspid Aortic Valve was diagnosed). Got the medical without any problems and have renewed it yearly since.

One thing you need to be aware of if not already is that a BAV will render you susceptible to bacterial endocarditis (inflammation of the heart due to bugs). If you get BE then this will cause you considerable problems with holding a medical certificate, not to mention the life problems that go with it (extended hospitalisation with extensive IV therapy to combat the condition). You will need antibiotic coverage for dental and surgery procedures to prevent this.

As the cardiologist told me when giving me the diagnosis....look after your self and come back and see me at 75 and we'll have a look and see IF we need to replace it then!....

Hope this helps....

Tinkicker

lineupandwait
13th Jul 2006, 11:11
I'm another with a bicuspid aortic valve, aged 28 with an Australian class-1 medical. I didn't mention the valve to the Doctor when I did the medical but from what has been said above doesn't seem to make any difference. I've been curious about any restrictions due to the valve but it's seem they only take affect if you have a mechnical valve.

As mentioned above the valve is part of a wider disorder, the Aorta itself needs monitoring as it can expand or form whats called an anuersym and rupture, for me this is more of a concern than the valve.

I'd be interested to hear if any other commercial pilots are flying after valve or Aorta replacement, it's great to see life can go on as normal.

rhovsquared
13th Jul 2006, 13:36
some folks have a biscuspid aortic :)

RBBB: this is not a disease and can be appreciated in a normal individual
in order to make this understandable I hvae to first explain the QRS axis

QRS axis is determined by looking at leads I and aVF (and sometines II)
lead I being an arm lead; lead aVF being an augmented femoral lead

right axis deviation (RAD) is shown when the lead I QRS point up and when aVF points down; extreme RAD is when leads I II and aVF all have a downward pointing QRS:

RAD could be indicative of right venetricular hypertrophy[enlarged right heart, on an posterior anterior and later chest X-rays] (RVH) or a RBBB. but if you had Eisenmnger's shunt I Don't think you'd have passed a Class III.

RBBB on an EKG appears (for those who understand, it is hard to explain in English an RSR' pattern instead of a normal QRS pattern leading to a somewhat Biphasic appearance in chest leads V1 and V6 and arm lead I.

what does that mean ?

I) may be present in a normal person.

II) may be associated with diseases affecting the 'right heart' or pulmonary circulation.
1. pulmonary hypertension, central venous pressure monitoring, but
there is usually a plethera of symptomology.
2. ischemia, can be ruled out with absence of signs (angina) or presence of cardiac enzymes- and echocardiography
3. atrial septal defect, and doppler studies should get rid of that one.
4. or if of recent occurance with pulmonary embolism (usually accompanied by shortness of breath (dypsnea). then you'll get a V/Q scan.

I wrote earlier that I'll start a thread on "EKG for pilots", but due to my own current cervical disc problems (which leaves me as a non-flying pilot for now :ugh:) I've been very busy with doctors and such myself but i haven't forgotten- admitedly it will include plentt of cutting and pasting from my original posts.:O

basic point is IN THE ABSENCE OF SYPTOMOLOGY EKG, MUST BE USED VERY JUDICIOUSLY AND CARDIAC ANOMALIES APPEAR ON MOST PERSONS EKG [ IF THEY WERE TO BE CONTINOUSLY RECORDED BY A 12 LEAD] BUT THE TOPIC IS VERY VERY COMPLEX, DON'T GET TOO TOO BOGGED DOWN ABOUT THEM -with the exception of asystole :} :} :}

rhovsquared :)

S3th17
1st Nov 2006, 14:34
thank you very much for your answers.

as far as I understood theres no problem if you have rbbb or bicuspid.. but what if you have them both? I mean they say in JAR-FCL 3 that its ok if theres no other ilness besides rbbb (you have to take additional tests), and in appendix 2 (if I remeber right) that BAV its acceptable if no other problems.... dont know what to think.. :ugh:

as far as I know I have no other heart problems besides these 2 (thank god :p )..

matt_hooks
24th Oct 2008, 13:23
Well, I wish I'd been as lucky as you guys and found out about the Bicuspid valve and aortic coarctation (narrowing, another of those genetic conditions that often occurs alongside a bicuspid valve) before they became a problem.

The alternative is to contract infective bacterial endocarditus (as mentioned above, mine was your good old streptococcus bacteria. Most people get a sore throat, I get two lots of open heart surgery!) which, due to a certain amount of medical incompetence from my family GP went undetected for nearly 2 1/2 months.

Result is an artificial replacement for the (completely destroyed, I saw the echocardiogram they did and there was almost as much flow back as forward through it) aortic valve, and also a replacement of a section of the downgoing aorta to repair the narrowing.

Cue Warfarin for life (apparently not a permissible drug for flying, although if it can be demonstrated as stable for 6 months then it's a possibility) and facing the possible loss of licence.

However, it's reassuring to see that the things I thought might have meant a complete end to my flying career, such as the valve replacement and the pacemaker, really aren't necessarily that. Just spoken to the lovely people at the CAA and they were extremely helpful. I'm still a bit wary about getting my hopes up of regaining my licence, but it seems there are people out there with similar experiences who are still flying!

Interesting to hear that it might leave me with a multi-crew only licence, I think after all that I've been through I'd be MORE than happy with that!

koi
15th Apr 2012, 19:48
Hi Folks,
Just had my bicuspid aortic valve replaced with a carbon fibre mechanical Aortic Valve and use Warfarin to regulate INR with self testing prior to flight. All ok with the UK CAA who have updated their Aortic Valve Replacement protocols on their excellent web site. Now a six month wait for new medical !
Warfarin is now allowed, mechanical valves are allowed with OML multi crew limitation. Hope that this helps to update the thread for other interested crew.

Good luck out there.

Koi Carpus