Flying with severe aortic stenosis

[Zara0006]

Hi everyone,

Sorry to create another thread for this but I’m receiving conflicting opinions about whether it is safe to fly (2x 6-hour flights each way), and really need some advice.

I finally received the numbers from my latest echo, which are:

AVA: 0.7cm
PV: 3.4m/s
Mean gradient: 21mmHg, max 44
LVEF: 62%
DI: 0.24
AR dilation: 4.2

Has anyone travelled long distance while it was severe and are you likely to be affected by reduced oxygen levels during the flight?

Thank you!

 

[Chuck C]

Hi Zara.

When I became severe, I was never told that I should not fly. The subject never came up, so I'm not sure if I would put any weight on my experience.

Your echo is interesting. Your AVA (valve area) is definitely in the severe zone. However, both your PV and mean pressure gradient would indicate that you are moderate.

I note also that they used DI, which stands for Dimensionless Index. My compliments to the clinic that completed your echo, because this is a very useful metric when there is such discordance. A DI < 0.25 would indicate severe, which would be in agreement with the AVA.

I hope that you get some clear guidance about whether you should fly. I hope that this does not cause you to cancel travel plans.

 

[Zara0006]

Hi Zara.

When I became severe, I was never told that I should not fly. The subject never came up, so I'm not sure if I would put any weight on my experience.

Thanks Chuck! They didn’t mention anything about the discordance but she spent a very long time on the echo yesterday and it seemed that things didn’t seem consistent, so I realised afterwards that this was the case.

I will try to obtain my echo results from a few months ago, the Cardiologist said that it was 0.8cm at that one but didn’t mention other values, I’ll try to find out thank you!

 

[Chuck C]

I will try to obtain my echo results from a few months ago, the Cardiologist said that it was 0.8cm at that one but didn’t mention other values, I’ll try to find out thank you!

In a previous post you indicated that you have symptoms and that they have become more severe over the past few months. So, there is probably not really any question as to you being severe, despite Vmax and mean pressure gradient not being consistent with AVA and DI. Worsening symptoms, combined with severe level of AVA and DI, I would think would be pretty conclusive. You also indicated that your team advised that it is time for surgery. I hope that you get it done soon.

 

[Croooser]

My AVA was .9 at it's worst. I flew to Cleveland for my surgery at CC. However, this is just a data point, not an opinion or recommendation.

 

[nobog]

Zarra0006 -

I would just not recommend walking from terminal 3 to terminal 2 at Heathrow in the underground tunnel .

Kidding aside, it really depends on your situation - do you have to haul luggage? Airports are all different and a connecting flight walk could be 100 feet or 1/4 mile. Air travel under the best of circumstances is hard, I would certainly suggest to not strain yourself excessively.

 

[pellicle]

I would certainly suggest to not strain yourself excessively.

and this is (to me) the nub of the issue.

but I’m receiving conflicting opinions about whether it is safe to fly (2x 6-hour flights each way), and really need some advice.

from who?

I hope not a doctor, because I can't see any basis for this apart from exersize (I mean unless you are so far advanced that you're already on oxygen).

You won't be doing aerobics on the flight, and just (as Nobog says) don't try to haul too much luggage. Its the airports not the flights.

But if you are already on oxygen because of reasons I don't know then yes, long haul flight would be challenging.

Best Wishes

PS a search reveals:

https://aerospace.honeywell.com/us/en/about-us/blogs/why-do-aircraft-use-cabin-pressurization

At cruising altitude, the cabin pressure is between approximately 11 and 12 pounds per square inch (PSI), simulating the pressure we'd experience on a mountain that is between 6,000 to 8,000 feet high.​

which is about what the average amount of air pressure is in Colorado
https://www.colorado.com/colorado-travel-facts
now, if you were flying unpressurised like in a military transport aircraft it might be different.

HTH

 

[vitdoc]

There is nothing certain in life. But the odds of you having a problem on a routine flight are very very low. If you were in a situation that an airplane flight was likely to be dangerous than you should have had surgery already.

 

[Zara0006]

Thanks for the advice everyone. My cardiologist is currently away, and the registrar I spoke to strongly advised against it after a quick look at my echo. He told me my travel insurance would not be valid and I’d be screwed if anything happened so I didn’t end up going. I’m not sure anything would’ve gone wrong, but it was more for my family’s benefit, as they were quite concerned about something happening.

Plus apparently apparently you shouldn’t fly long distance when severe and symptomatic. I’m not experiencing anything major, but definitely out of breath when bending down, climbing stairs or lying down, so I don’t think I can claim to be asymptomatic now!

 

[Zara0006]

Zarra0006 -

I would just not recommend walking from terminal 3 to terminal 2 at Heathrow in the underground tunnel .

Kidding aside, it really depends on your situation - do you have to haul luggage? Airports are all different and a connecting flight walk could be 100 feet or 1/4 mile. Air travel under the best of circumstances is hard, I would certainly suggest to not strain yourself excessively.

Yes very true! The good thing about Heathrow is that you can request assistance and they are excellent (family members have used it, I probably wouldn’t as I don’t have many issues walking on flat surfaces).

 

[Chuck C]

Thanks for the advice everyone. My cardiologist is currently away, and the registrar I spoke to strongly advised against it after a quick look at my echo. He told me my insurance would not be valid and I’d be screwed if anything happened so I didn’t end up going. I’m not sure anything would’ve gone wrong, but it was more for my family’s benefit, as they were quite concerned about something happening.

You have indicated that your coverage is the NHS. So, the NHS would not cover you if you took a flight, against recommendations, and something happened? Are you sure that this is correct? If something happens and you need care, they actually investigate whether said activity was against recommendations before they decide to give care? This does not sound right. I'm not in England in that system, so I really don't know, but that just doesn't sound correct.

BTW, I'm not suggesting that you should have gone against your doctor's recommendation and travelled, but I just have a hard time believing that the NHS would not have covered you.

 

[Zara0006]

Hi Chuck, sorry I meant if anything happened abroad while I was on holiday or on one of the flights, as I’d then be 12 hours away from home and possibly with invalidated travel insurance. The NHS would most definitely cover you, regardless!

 

[dornole]

So …. Since you’re symptomatic, when is your surgery scheduled? Short of breath lying down is symptomatic for sure.

 

[pellicle]

So …. Since you’re symptomatic, when is your surgery scheduled? Short of breath lying down is symptomatic for sure.

This

 

[Zara0006]

I was supposed to have an appointment with the surgeon last week but it was cancelled, so I guess I’ll find out in another couple of weeks. I think they’re confused with my results, as Chuck mentioned my PV and mean pressure gradient are moderate but AVA suggests severe. The DI being <25 was a good point though, I’ve researched that and it seems to be a good indicator the stenosis is severe and indicates poor prognosis.

I have however obtained my results from about a year ago, and everything was pretty much the same, DI was still 0.24 and AVA 0.8cm, and I travelled a lot and did climbing etc. The difference is that I was asymptomatic at the time so I guess they weren’t too concerned.

 

[dornole]

Symptomatic changes everything so give your docs the info they need, I would send a medical message.