Natural history of mitral valve prolapse in military aircrew

Objective: Mitral valve prolapse (MVP) is a common cardiac abnormality whose natural history differs among various patient populations. High-performance flight is associated with exposure to varying acceleration forces and strenuous isometric physical activity. The effect of the military flying environment on the natural history and progression of MVP is poorly defined. Methods: We evaluated a cohort which included all military aviators in the Israeli Air Force diagnosed with MVP. Medical records and echocardiographic studies of participants were reviewed for the development of clinical or echocardiographic complications. Results: The study population was comprised of 24 aviators, 14 of whom were high-performance aviators. Average follow-up was 23.5 years (total 563 person-years). Four aviators suffered from MVP-related complications including 2 cases of flail valve due to chordae rupture and 1 case each of newly diagnosed atrial fibrillation and infective endocarditis. Progression of asymptomatic mitral regurgitation was identified in 11 aviators. Conclusions: Military aviators with MVP may be prone to serious medical complications. A detrimental effect of high-performance flight on patients with MVP is suggested.