Mitral valve disease
What the FAA's documents say about mitral valve disease, in plain words, with the FAA's own words one press away.
FAA term: Mitral Valve Disease (Mitral Regurgitation; Mitral Insufficiency; Mitral Valve Prolapse (MVP))Covers: All classes
- A repair of the mitral valve has its own FAA disposition table and CACI worksheet, whose surgery line names primary mitral valve disease, and its own page. Row C of this table points to that table if valve surgery has been performed.
- Row C of this table points to the Protocol for Cardiac Valve Replacement if valve surgery has been performed, and that protocol has its own page.
Short version
The Mitral Valve Disease disposition table has three rows, based on the echo results.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AMild or trace, with no symptoms | Examiner issues | Examiner can issue |
| Row BModerate, with no symptoms | Defers to the FAA | Special Issuance |
| Row CSevere, or with symptoms of any severity | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Mitral valve disease
- Row A · Examiner can issue
Mild or trace (based on the echo results) mitral valve regurgitation, mitral valve insufficiency or mitral valve prolapse (MVP), and asymptomatic. The examiner should review the echo -- copies of the most recent 2-D and Doppler flow study report -- or a clinical problem list or progress note which lists the echo findings as mild. If the examiner can determine the condition is asymptomatic and the valve disease is mild, the table says ISSUE, and has the examiner annotate this information in Block 60.
MILD or TRACE (based on ECHO results) • Mitral Valve regurgitation; or • Mitral Valve insufficiency; or • Mitral Valve Prolapse (MVP); AND Asymptomatic … The AME should review: 1. Echocardiogram (Echo). Copies of the most recent 2-D and Doppler flow study report. OR A clinical problem list or progress note which lists the echo findings as mild. … If the AME can determine the condition is Asymptomatic and the valve disease is MILD: ISSUE … Annotate this information in Block 60.
- Row B · Special Issuance
Moderate (based on the echo results) mitral valve regurgitation, mitral valve insufficiency or mitral valve prolapse (MVP), and asymptomatic. The table lists what to submit for FAA review -- a current, detailed progress note, an echo from no more than 90 days before the exam, and a 24-hour cardiac monitor from no more than 90 days before the exam. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
MODERATE (based on ECHO results) • Mitral Valve regurgitation; or • Mitral Valve insufficiency; or • Mitral Valve Prolapse (MVP); AND Asymptomatic … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
- Row C · Special Issuance
Severe (based on the echo results) mitral valve regurgitation, mitral valve insufficiency or mitral valve prolapse (MVP), or symptomatic, of any severity -- for example chest pain, palpitations, fatigue, shortness of breath, dizziness or pre-syncopal episodes. The table lists what to submit for FAA review -- a current, detailed progress note and an echo from no more than 12 months before the exam. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
SEVERE (based on ECHO results) • Mitral valve regurgitation; or • Mitral valve insufficiency; or • Mitral Valve Prolapse (MVP); OR Symptomatic (any severity) (e.g. Chest pain, palpitations, fatigue, shortness of breath, dizziness or pre-syncopal episodes) … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
- A note on the table, 1
The Item 36 page on valvular disease points to this disposition table for mitral valve disease, naming mitral regurgitation, mitral insufficiency and mitral valve prolapse (MVP).
* For Mitral Valve Disease [Mitral Regurgitation, Mitral Insufficiency, Mitral Valve Prolapse (MVP)] see disposition table .
- A note on the table, 2
Rows B and C each note that for asymptomatic individuals, an echo report that reads mild to moderate uses row B (moderate), and one that reads moderate to severe uses row C (severe).
Note: For Asymptomatic individuals, if the ECHO report reads mild to moderate, use row B (Moderate). If it reads moderate to severe, use row C (Severe).
- A note on the table, 3
Row C says that if valve surgery has been performed, see the Mitral Valve Repair disposition table or the Protocol for Cardiac Valve Replacement.
If valve surgery has been performed, see: • Mitral Valve Repair Disposition Table or • Protocol for Cardiac Valve Replacement
The FAA pathways for mitral valve disease
Which exam
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: The echo for your AME
Row A: what the examiner reviews.Copies of the most recent 2-D and Doppler flow study echo report, or a clinical problem list or progress note which lists the echo findings as mild, for your AME to review.
Show the FAA's words: The echo for your AME
The AME should review: 1. Echocardiogram (Echo). Copies of the most recent 2-D and Doppler flow study report. OR A clinical problem list or progress note which lists the echo findings as mild.
FAA source: Mitral Valve Disease Disposition Table. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
Step 2: See your AME
The examiner should review the echo -- copies of the most recent 2-D and Doppler flow study report -- or a clinical problem list or progress note which lists the echo findings as mild. If the examiner can determine the condition is asymptomatic and the valve disease is mild, the table says ISSUE, and has the examiner annotate this information in Block 60.Exam day- The examiner should review the echo -- copies of the most recent 2-D and Doppler flow study report -- or a clinical problem list or progress note which lists the echo findings as mild. If the examiner can determine the condition is asymptomatic and the valve disease is mild, the table says ISSUE, and has the examiner annotate this information in Block 60.
Show the FAA's words: See your AME
MILD or TRACE (based on ECHO results) • Mitral Valve regurgitation; or • Mitral Valve insufficiency; or • Mitral Valve Prolapse (MVP); AND Asymptomatic
The AME should review: 1. Echocardiogram (Echo). Copies of the most recent 2-D and Doppler flow study report. OR A clinical problem list or progress note which lists the echo findings as mild.
If the AME can determine the condition is Asymptomatic and the valve disease is MILD: ISSUE
Annotate this information in Block 60.
FAA source: Mitral Valve Disease Disposition Table. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The examiner should review the echo -- copies of the most recent 2-D and Doppler flow study report -- or a clinical problem list or progress note which lists the echo findings as mild. If the examiner can determine the condition is asymptomatic and the valve disease is mild, the table says ISSUE, and has the examiner annotate this information in Block 60.
Row BDefers to the FAASpecial Issuance
The table lists what to submit for FAA review -- a current, detailed progress note, an echo from no more than 90 days before the exam, and a 24-hour cardiac monitor from no more than 90 days before the exam. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
If the examiner defersRow CDefers to the FAASpecial Issuance
The table lists what to submit for FAA review -- a current, detailed progress note and an echo from no more than 12 months before the exam. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Mild or trace (based on the echo results) mitral valve regurgitation, mitral valve insufficiency or mitral valve prolapse (MVP), and asymptomatic. The examiner should review the echo -- copies of the most recent 2-D and Doppler flow study report -- or a clinical problem list or progress note which lists the echo findings as mild. If the examiner can determine the condition is asymptomatic and the valve disease is mild, the table says ISSUE, and has the examiner annotate this information in Block 60.
MILD or TRACE (based on ECHO results) • Mitral Valve regurgitation; or • Mitral Valve insufficiency; or • Mitral Valve Prolapse (MVP); AND Asymptomatic … The AME should review: 1. Echocardiogram (Echo). Copies of the most recent 2-D and Doppler flow study report. OR A clinical problem list or progress note which lists the echo findings as mild. … If the AME can determine the condition is Asymptomatic and the valve disease is MILD: ISSUE … Annotate this information in Block 60.
- Row B · Special Issuance
Moderate (based on the echo results) mitral valve regurgitation, mitral valve insufficiency or mitral valve prolapse (MVP), and asymptomatic. The table lists what to submit for FAA review -- a current, detailed progress note, an echo from no more than 90 days before the exam, and a 24-hour cardiac monitor from no more than 90 days before the exam. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
MODERATE (based on ECHO results) • Mitral Valve regurgitation; or • Mitral Valve insufficiency; or • Mitral Valve Prolapse (MVP); AND Asymptomatic … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
- Row C · Special Issuance
Severe (based on the echo results) mitral valve regurgitation, mitral valve insufficiency or mitral valve prolapse (MVP), or symptomatic, of any severity -- for example chest pain, palpitations, fatigue, shortness of breath, dizziness or pre-syncopal episodes. The table lists what to submit for FAA review -- a current, detailed progress note and an echo from no more than 12 months before the exam. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
SEVERE (based on ECHO results) • Mitral valve regurgitation; or • Mitral valve insufficiency; or • Mitral Valve Prolapse (MVP); OR Symptomatic (any severity) (e.g. Chest pain, palpitations, fatigue, shortness of breath, dizziness or pre-syncopal episodes) … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
If the examiner defersSpecial Issuance
Row B, moderate valve disease on the echo with no symptoms, is marked DEFER.
Row C, severe valve disease on the echo, or symptoms of any severity, is marked DEFER.
The AASI says that if this is a first-time application for an AASI for mitral valve disease, and the applicant has all the requisite medical information necessary for a determination, the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination. This line is about an application for an AASI; row A of the disposition table is marked ISSUE and does not mention an AASI.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
Row B, moderate valve disease on the echo with no symptoms, is marked DEFER.
MODERATE (based on ECHO results) … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 2
Row C, severe valve disease on the echo, or symptoms of any severity, is marked DEFER.
SEVERE (based on ECHO results) … OR Symptomatic (any severity) … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 3
The AASI says that if this is a first-time application for an AASI for mitral valve disease, and the applicant has all the requisite medical information necessary for a determination, the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination. This line is about an application for an AASI; row A of the disposition table is marked ISSUE and does not mention an AASI.
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
After the FAA decides
AASIThe AASI says an FAA physician provides the initial certification decision and grants the Authorization, and that examiners may then reissue under the Authorization where the applicant provides what the AASI lists.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. … AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
The disposition table is headed All Classes.
Show the FAA's words: how often the FAA asks again
MITRAL VALVE DISEASE Mitral Regurgitation, Mitral Insufficiency, Mitral Valve Prolapse (MVP) All Classes
Under the provisions of an Authorization, the AASI says examiners may reissue when the applicant provides the Authorization granted by the FAA, a detailed progress note from the treating cardiologist, and a current 2-D echo with Doppler performed within the last 90 days.
Show the FAA's words: at later exams
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; … A detailed Clinical Progress Note from the treating cardiologist describing … A current 2-D echocardiogram (Echo) with Doppler performed within the last 90 days.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI's list for a reissue begins with the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA;
A detailed progress note from the treating cardiologist
The AASI asks for a detailed clinical progress note from the treating cardiologist, describing current clinical findings, any symptoms, new arrhythmia, "develop of a severe murmur" (as printed) or any severe valve regurgitation, valve insufficiency or valve prolapse, or whether surgery is recommended.
Show the FAA's words: A detailed progress note from the treating cardiologist
A detailed Clinical Progress Note from the treating cardiologist describing current clinical findings, any symptoms, new arrhythmia, develop of a severe murmur or any severe valve regurgitation, valve insufficiency or valve prolapse or if surgery is recommended; and
A current 2-D echo with Doppler
The AASI asks for a current 2-D echocardiogram (echo) with Doppler, performed within the last 90 days.
Show the FAA's words: A current 2-D echo with Doppler
A current 2-D echocardiogram (Echo) with Doppler performed within the last 90 days.
What the Authorization letter comes with
The AASI says the Authorization letter comes with attachments that specify the information the treating physicians must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI says the examiner must defer to the AMCD or Region if new symptoms occur, an arrhythmia develops, the treating physician or examiner reports a severe murmur, or the echo report identifies severe valve regurgitation, valve insufficiency or valve prolapse.
Show the FAA's words: When the examiner defers a reissue
The AME must defer to the AMCD or Region if: … New symptoms occur; OR … An arrhythmia develops; OR … The treating physician or AME reports a severe murmur; OR … Echo report identifies SEVERE Valve Regurgitation, Valve Insufficiency or Valve Prolapse.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Row A's heading says mild or trace, its ISSUE line says mild
Row A is headed mild or trace (based on the echo results), but its disposition says ISSUE if the examiner can determine the condition is asymptomatic and the valve disease is mild. The table does not say how a trace finding is read against that line; both are shown as printed.
Show the FAA's words: good to know, 2
MILD or TRACE (based on ECHO results) … If the AME can determine the condition is Asymptomatic and the valve disease is MILD: ISSUE
A mild-to-moderate echo uses row B
For asymptomatic individuals, the table says an echo report that reads mild to moderate uses row B (moderate), and one that reads moderate to severe uses row C (severe).
Show the FAA's words: good to know, 3
Note: For Asymptomatic individuals, if the ECHO report reads mild to moderate, use row B (Moderate). If it reads moderate to severe, use row C (Severe).
Rows B and C date the echo differently
Row B lists an echo report from no more than 90 days before the exam, and row C one from no more than 12 months before the exam. Row B's list goes on to a 24-hour cardiac monitor; row C's list ends at the echo.
Show the FAA's words: good to know, 4
3. Echocardiogram (Echo). Copies of a 2-D and Doppler flow study report performed no more than 90 days prior to the AME exam. … 4. 24-hour cardiac monitor performed no more than 90 days prior to the AME exam. … 3. Echocardiogram (Echo). Copies of a 2-D and Doppler flow study report performed no more than 12 months prior to the AME exam
Symptoms of any severity use row C
Row C covers symptomatic valve disease of any severity, for example chest pain, palpitations, fatigue, shortness of breath, dizziness or pre-syncopal episodes.
Show the FAA's words: good to know, 5
OR Symptomatic (any severity) (e.g. Chest pain, palpitations, fatigue, shortness of breath, dizziness or pre-syncopal episodes)
A first application for an AASI is deferred to the FAA
The AASI says that if this is a first-time application for an AASI for mitral valve disease, and the applicant has all the requisite medical information necessary for a determination, the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination. This line is about an application for an AASI; row A of the disposition table is marked ISSUE and does not mention an AASI.
Show the FAA's words: good to know, 6
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Severe findings send a reissue to the FAA
The AASI has the examiner defer to the AMCD or Region if the treating physician or examiner reports a severe murmur, or the echo report identifies severe valve regurgitation, valve insufficiency or valve prolapse.
Show the FAA's words: good to know, 7
The AME must defer to the AMCD or Region if: … The treating physician or AME reports a severe murmur; OR … Echo report identifies SEVERE Valve Regurgitation, Valve Insufficiency or Valve Prolapse.
The echo is a 2-D echo with Doppler
For a reissue, the AASI asks for a current 2-D echocardiogram with Doppler, performed within the last 90 days.
Show the FAA's words: good to know, 8
A current 2-D echocardiogram (Echo) with Doppler performed within the last 90 days.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Mitral Valve Disease Disposition TableOpen to print: Mitral Valve Disease Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- AASI – Mitral Valve DiseaseOpen to print: AASI – Mitral Valve Disease, a PDF at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Open at the FAA: Item 36 – Valvular Disease, a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.