军事飞行员主动脉瓣二瓣化畸形5例并文献复习

Five cases of military pilots with bicuspid aortic valves and literature review

目的总结军事飞行员主动脉瓣二瓣化畸形(bicuspid aortic valve,BAV)的临床特点和航空医学鉴定结果,提高对军事飞行员BAV的认识。方法收集2013年1月—2021年1月于空军特色医学中心检查确诊为BAV的5例军事飞行员的临床资料,回顾性分析BAV的临床诊治、病情进展和航空医学鉴定情况。结果5例BAV军事飞行员均为年度体检或改装体检时经心脏超声检查确诊,年龄23~51岁。心脏超声提示:3例左冠瓣与右冠瓣融合,2例右冠瓣与无冠瓣融合;5例均伴有主动脉瓣反流,其中2例为轻度,2例为中度,1例为重度且伴主动脉瓣轻度狭窄;1例主动脉瓣增厚,1例主动脉瓣钙化;3例升主动脉扩张;2例左室扩大。经专家评估:4例需密切随访观察,1例择期行Bentall术。经航空医学鉴定:2例原机种飞行合格,1例改装飞行合格,2例暂时飞行不合格。结论军事飞行员BAV具有临床症状轻、并发症出现早、病情进展快的特点。长期军事训练及航空环境下抗荷动作可能加速BAV病情进展。

Objective To summarize the clinical characteristics and aviation medical identification results of bicuspid aortic valves in military pilots,and to advance our understanding of BAV in military pilots.Methods The clinical data of 5 military pilots diagnosed with BAV in our hospital between January 2013 and January 2021 was collected,while the clinical diagnosis and treatment,disease progression and aviation medical identification of BAV were retrospectively analyzed.Results All the five military pilots with BAV,aged 23 to 51,were confirmed by cardiac ultrasound examination during annual physical examination or physical examination for flying new aircraft.Cardiac ultrasonography showed that left and right coronary valves fused in three cases,and right and no coronary valves fused in two cases.Aortic regurgitation was found in all the five cases,including two mild cases,two moderate cases,and one severe case with mild aortic stenosis.There was one case of aortic valve thickening,one case of aortic valve calcification and three cases of ascending aorta dilatation.Left ventricular enlargement occurred in two cases.Experts recommended close follow-up and observation for four cases and Bentall for one case.After aviation medical identification,two pilots who would fly aircraft of the original type were determined as qualified,so was one pilot who would f ly a modified type,and 2 cases of temporary flight were evaluated as unqualified.Conclusion BAV in military pilots are characterized by light clinical symptoms,early complications and rapid disease progression.Long-term military training and anti-load action in an aviation environment may accelerate the progression of BAV.