Medical assessment of atrial septal defect in fighter pilots —2 cases attached

Abstract

Objective To explore the treatment,aviation medical follow-up and assessment principles of secundum atrial septal defect cases in fighter pilots.Methods The clinical treatment,aviation assessment process and the assessment conclusion of two cases of fighter pilot with secundum atrial septal defect were analyzed and related literature were reviewed.Results The two fighter pilots were casually discovered having secundum atrial septal defect during annual physical examination with no clinical syndromes or signs.The transesophageal echocardiography showed that the defects were less than 10 mm in diameter and the sizes of the heart chambers were normal.The brain images showed that there was no infarction caused by paradoxical embolization.Both pilots successfully underwent percutaneous closure of the defect by using Amplatzer device.By 9～13 months follow-up,the echocardiography showed normal heart functions and no residual shunt.Also no arrthymia was detected by ambulatory electrocardiogram.The Amplatzer devices were stable and the heart functions were normal in human-centrifuge examination and pressure breathing test.Both pilots were wavered for flight.One had gotten the waiver flying with other qualified pilot for 120 h then resumed to his normal duties due to his proper adaptation and normal heart rhythm in air.The other one was still in the limit of co-flying.Conclusion The fighter pilots may get waiver permission to fly as they have successful closure of secundum atrial septal defect and with stable cardio-hemodynamic.The evaluation of flight adaptability should include not only routine postoperative auxiliary examinations,such as echocardiography,ambulatory electrocardiogram and myocardium enzyme studies,but also the examinations that reflect flight endurance,such as sub-maximal exercise test,human centrifuge test and pressure breathing test.Flying certification should be given carefully and progressively.Appropriate aerial physiological monitoring may be helpful in follow-up. Key words: Heart septal defect, atrial; Eligibility determination; Physical examination; Catheter ablation