Medical Certification of a Pilot with Tetralogy of...
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Medical Certification of a Pilot with Tetralogy of Fallot USAF School of Aerospace Medicine Mayo Clinic, Rochester Minnesota Dan ‘Danger’ Mirski, MD, MPH, CPE Col(sel), USAF, MC, CFS Jason ‘Dexter’ Cromar, MD, MPH Capt, USAF, MC, DMO, FS Clayton T. Cowl, MD, MS Medical Director|Mayo Clinic Preferred Response Distribution A: Approved for public release, Unlimited Distribution; Case number 88ABW-2013-1174; 13 Mar 2013
Transcript of Medical Certification of a Pilot with Tetralogy of...
Medical Certification of a Pilot with
Tetralogy of FallotUSAF School of Aerospace Medicine
Mayo Clinic, Rochester Minnesota
Dan ‘Danger’ Mirski, MD, MPH, CPECol(sel), USAF, MC, CFS
Jason ‘Dexter’ Cromar, MD, MPHCapt, USAF, MC, DMO, FS
Clayton T. Cowl, MD, MSMedical Director|Mayo Clinic Preferred Response
Distribution A: Approved for public release, Unlimited Distribution; Case number 88ABW-2013-1174; 13 Mar 2013
Disclosure Information84th Annual Scientific Meeting
Drs. Dan Mirski, Clayton Cowl and Jason Cromar
Case number 88ABW-2013-1174; 13 Mar 2013
We have no financial relationships to disclose.
We will not discuss off-label use and/or investigational use in our presentation.
Presenting History 21 yo WM born with Tetralogy of Fallot
Neonatal Cyanosis Cardiac Echo TOF Surgical correction at age 1 Overall normal development
Dreams of becoming a pilot Attends University; Prof. Pilot Studies
Pulmonary Valve & aortic root surgery at 19 Can such an individual realize his dream?!?
Case number 88ABW-2013-1174; 13 Mar 2013
Presenting HistoryCan such an individual – with such a
serious illness – ever pass a 1st Class Flying physical
Or even a Student Pilot medical certificate?
Case number 88ABW-2013-1174; 13 Mar 2013
Presenting History PMH & PSH: TOF as above + …
At 9yo, develops a limp Dx: Legg-Calve-Perthes
Inadequate blood supply to the hip joint
Meds: Daily bASA 81mg ALL: NKDA FH: HTN; No congenital CV abnormalities (22q11 del) SH: Rare EtOH; No Smoking or Drugs
Case number 88ABW-2013-1174; 13 Mar 2013
Doctor, Your Next Patient is Here
YOU’RE THE AME …
WHAT DO YOU DO?
Case number 88ABW-2013-1174; 13 Mar 2013
TOF Pathology Pulmonary stenosis (PS)
due to a narrowing of the pulmonary outflow tract
Overriding aorta: shifted over the VSD and right ventricle
Ventricular septal defect (VSD) Right ventricular hypertrophy (RVH)
Case number 88ABW-2013-1174; 13 Mar 2013
Case number 88ABW-2013-1174; 13 Mar 2013
Physical Examination Appears stated age of 21 yo in NAD VS normal
SEM, grade III/VI heard best over LLSB
Well healed prominent 27cm vertical scar AC midline Normal distal pulses
Normal Pulmonary and rest of exam
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Aeromedical ConcernsRisk of a sudden incapacitating event over the time period of the medical certificateArrhythmiasResidual VSDRe-stenosisProgression of pulmonary valve and arteries abnResidual pulmonary insufficiencySurgical complications
Case number 88ABW-2013-1174; 13 Mar 2013
FAA Civil Aerospace Medical Institute (CAMI)
Expert consultation ensure that there are no “functional, or structural
disease, defect, or limitation that … makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held.”
Labs, EKG Radiographic studies
Echocardiogram Cardiac MRI
Case number 88ABW-2013-1174; 13 Mar 2013
AME & FAA Partnership MAYO Clinic in conjunction with pt’s PMD Presented normal:
Hemodynamics Right ventricular and outflow tract function Ejection fraction
FAA reassure that airman has a low risk for sudden cardiac death or progression of disease prior to certificate expiration date.
Pt received a special issuance FAA Flying Class 1 medical certificate
Case number 88ABW-2013-1174; 13 Mar 2013
Summary Neonate: Cyanosis 1: TOF Surgery 9: Limp; Legg-Calve-Perthes 16: FAA student certificate under a special issuance 19: Porcine pulmonary valve replacement
6 month interim period
21: Junior year in undergraduate Flying Studies – Maintains a 1st class medical cert.
246 Flying Hours
Case number 88ABW-2013-1174; 13 Mar 2013
Questions?
