title: Effect of G-force on bicuspid aortic valve in aviators.
abstract: OBJECTIVE
  Bicuspid aortic valve (BAV) is a common congenital cardiac malformation. The major complications are aortic stenosis (AS), aortic regurgitation (AR), infectious endocarditis and aortic dissection. This paper aims to assess the hemodynamic importance of incidentally-found BAV in military aviators and evaluate the effect of high G-force on disease progression.
  
  
  METHODS
  Aviators with BAV were detected by reviewing all cardiac assessment records between 1987 and 2005. All aviators underwent annual flight surgeon examination. Echocardiography was performed as recommended by our cardiologists and flight surgeons.
  
  
  RESULTS
  Eight newly diagnosed cases of BAV were found. All of the aviators continued active aviation throughout the study period. Repeat echocardiography demonstrated progressive widening of the aortic diameter in five of the eight aviators. No worsening of valve dysfunction was seen in those with mild aortic regurgitation at diagnosis. Left ventricular dimensions and function did not deteriorate. No new valve complications, including infectious endocarditis, were seen. The age at diagnosis strongly correlated with the root diameter change; both total (r = 0.74, p = 0.02) and annualized (r = 0.78, p = 0.02) change. Over a mean follow-up period of 12.1 years, no difference was seen in the progression of BAV in high-performance as compared to low-performance aviators.
  
  
  CONCLUSIONS
  Exposure to G-force and anti-G maneuvers does not appear to worsen cardiac and valve function in aviators with BAV.
authors.affiliation: Israel Aeromedical Center, IAF, Tel Hashomer, Israel. carterd@zahav.net.il
authors.forename: Dan
authors.initials: D
authors.lastname: Carter
authors.forename: Russell
authors.initials: R
authors.lastname: Pokroy
authors.forename: Bella
authors.initials: B
authors.lastname: Azaria
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Alex
authors.initials: A
authors.lastname: Prokopetz
authors.forename: Erez
authors.initials: E
authors.lastname: Barenboim
authors.forename: David
authors.initials: D
authors.lastname: Harpaz
authors.forename: Liav
authors.initials: L
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000337:Aerospace Medicine; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler; D018470:Gravity, Altered / Q000009:adverse effects*; D006349:Heart Valve Diseases / Q000209:etiology*; D006801:Humans; D008297:Male