Mitral leaflet prolapse.

Mitral leaflet prolapse (MLP) is a common condition but sudden or subtle incapacity will occasionally present due to (a) arrhythmia, (b) systemic emboli, (c) sudden onset of severe mitral regurgitation due to chordal rupture, (d) non-anginal chest pain. It seems reasonable to allow asymptomatic subjects with MLP to maintain unrestricted flying status provided that they have no family history of sudden death, no evidence of significant arrhythmia on Holter electrocardiographic monitoring, a normal exercise electrocardiogram, and no increase in left atrial or left ventricular dimensions on the echocardiogram. The Holter recording, exercise test and echocardiogram may need to be repeated at intervals. Any departure from these requirements might require restriction to multi-crew operation only.