Mitral valve repair
What the FAA's documents say about mitral valve repair, in plain words, with the FAA's own words one press away.
Short version
The Mitral Valve Repair disposition table has two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AThe repair was 5 or more years ago, and there are no co-morbid conditions. | Worksheet | CACI |
| Row BThe repair was less than 5 years ago, or any of the co-morbid conditions the table lists. | Defers to the FAA | FAA review |
Show the FAA's words: the FAA's table for Mitral valve repair
- Row A · CACI
The repair was 5 or more years ago, and there are no co-morbid conditions. The table sends the examiner to the CACI worksheet for mitral valve repair, and has the examiner annotate Block 60. Its note to the pilot says to take the CACI worksheet to the cardiologist so they can fully address the FAA requirements.
5 or more years ago and no co-morbid conditions* … See CACI – Mitral Valve Repair Worksheet. … Note to pilot: Take the CACI worksheet to your cardiologist so they can fully address the FAA requirements. … Follow the CACI – Mitral Valve Repair Worksheet Annotate Block 60.
- Row B · FAA review
The repair was less than 5 years ago, or any of the co-morbid conditions the table lists. After a 3-month recovery period the information the table lists is submitted to the FAA for review. The examiner defers and submits the information to the FAA for review.
Less than 5 years ago OR Any of the co-morbid conditions below* … After a 3-month recovery period submit the following to the FAA for review: … DEFER Submit the information to the FAA for review.
- A note on the table, 1
The table lists what co-morbid conditions for FAA purposes include, in its own terms.
*Co-morbid conditions for FAA purposes include: … Cardiac disease (disease of other valves, ischemia, CHF, Left Ventricular Systolic Dysfunction (LVSD), Secondary or Functional mitral valve disease, arrhythmia, etc.); … Connective tissue disorder (such as Marfan’s or Ehlers-Danlos, etc.); … Warfarin (Jantoven) or other anticoagulation (other than ASA) due to a cardiac condition; … Lung disease such as COPD (considered moderate to severe; any FEV1 or FVC less than 70%) or Pulmonary Hypertension; or … Residual Mitral valve regurgitation listed as moderate or higher on cardiac echo.
The FAA pathways for mitral valve repair
- How this pathway works: CACIConditions AMEs Can IssueRow A
- FAA reviewYour AME defers. The FAA decides.Row B
Your step-by-step plan
Step 1: The progress note from the treating cardiologist
The note the examiner reviews, and what it verifies.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
It verifies
- Asymptomatic and stable
- No other current cardiac conditions
- No new conditions, arrhythmias or complications that would affect cardiac function
- No more than a routine annual follow-up required
- No additional surgery anticipated or recommended
Show the FAA's words: The progress note from the treating cardiologist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
The treating cardiologist’s current, detailed Clinical Progress Note verifies:
Is asymptomatic and stable;
Has no other current cardiac conditions;
Has not developed any new conditions, arrhythmias, or complications that would affect cardiac function;
Requires no more than a routine annual follow-up; and
No additional surgery is anticipated or recommended.
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
Step 2: The most recent echo
Performed within the last 24 months, and what it shows.Your most recent echo, performed within the last 24 months.
It shows
- Mitral valve regurgitation, if present, classified as mild
No other abnormalities, such as
- Not: Dilated aorta greater than 4 cm
- Not: Hypertrophic cardiomyopathy or other cardiomyopathy
- Not: Left atrial enlargement
- Not: Aortic regurgitation or insufficiency, of any severity
- Not: Regurgitation of any valve, moderate or higher
- Not: Structural abnormalities, such as a dilated ventricle or atria
Not every exam
An annual echo is not required for each FAA exam for this CACI.
Show the FAA's words: The most recent echo
The most recent echo was performed within the last 24 months shows:
Mitral valve regurgitation (if present) is classified as mild;
No other abnormalities on echo such as:
Dilated aorta greater than 4 cm;
Hypertrophic cardiomyopathy or other cardiomyopathy;
Left Atrial Enlargement;
Aortic regurgitation/insufficiency (any severity);
Regurgitation of any valve moderate or higher; or
Structural abnormalities (dilated ventricle, atria, etc.)
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
An annual echo is not required for each FAA exam for this CACI.
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
Step 3: The worksheet's criteria
The surgery, your history, and the worksheet's notes.Mitral valve repair surgery 5 or more years ago, for primary mitral valve disease.
Not for
- Not: Secondary MR or functional MR due to coronary heart disease, MI, ischemic disease or cardiomyopathy
No history of
- Not: Connective tissue disorder, such as Marfan's or Ehlers-Danlos
- Not: Lung disease: COPD (moderate or higher), or pulmonary HTN
- Not: Other cardiac disease, such as congestive heart failure, ischemia or other valve disease
The worksheet's notes
If any valve other than mitral was involved, the information must be submitted to the FAA for review.
If warfarin (Jantoven) or other anticoagulation (other than ASA) is required for a cardiac condition, the examiner should defer.
Show the FAA's words: The worksheet's criteria
The airman had Mitral Valve Repair surgery 5 or more years ago for primary mitral valve disease (not secondary MR or functional MR due to coronary heart disease, MI, ischemic disease, or cardiomyopathy). [ ] Yes
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
The airman has NO history of:
Connective tissue disorder (Marfan’s or Ehlers-Danlos, etc.);
Lung disease: COPD (moderate or higher), or pulmonary HTN; or
Other cardiac disease (e.g., Congestive Heart Failure, ischemia, other valve disease, etc.)
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
If any valve other than mitral was involved, the information must be submitted to the FAA for review.
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
Anticoagulation is not routinely required for mitral valve repair. If warfarin (Jantoven) or other anticoagulation (other than ASA) is required for a cardiac condition, the AME should defer.
FAA source: CACI – Mitral Valve Repair Worksheet. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AWorksheetCACI
The table sends the examiner to the CACI worksheet for mitral valve repair, and has the examiner annotate Block 60. Its note to the pilot says to take the CACI worksheet to the cardiologist so they can fully address the FAA requirements.
Row BDefers to the FAAFAA review
After a 3-month recovery period the information the table lists is submitted to the FAA for review. The examiner defers and submits the information to the FAA for review.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · CACI
The repair was 5 or more years ago, and there are no co-morbid conditions. The table sends the examiner to the CACI worksheet for mitral valve repair, and has the examiner annotate Block 60. Its note to the pilot says to take the CACI worksheet to the cardiologist so they can fully address the FAA requirements.
5 or more years ago and no co-morbid conditions* … See CACI – Mitral Valve Repair Worksheet. … Note to pilot: Take the CACI worksheet to your cardiologist so they can fully address the FAA requirements. … Follow the CACI – Mitral Valve Repair Worksheet Annotate Block 60.
- Row B · FAA review
The repair was less than 5 years ago, or any of the co-morbid conditions the table lists. After a 3-month recovery period the information the table lists is submitted to the FAA for review. The examiner defers and submits the information to the FAA for review.
Less than 5 years ago OR Any of the co-morbid conditions below* … After a 3-month recovery period submit the following to the FAA for review: … DEFER Submit the information to the FAA for review.
The CACI worksheet's criteria
Progress note
- Asymptomatic and stable
- No other current cardiac conditions
- No new conditions, arrhythmias or complications that would affect cardiac function
- No more than a routine annual follow-up required
- No additional surgery anticipated or recommended
Echo report
It shows
- Mitral valve regurgitation, if present, classified as mild
No other abnormalities, such as
- Not: Dilated aorta greater than 4 cm
- Not: Hypertrophic cardiomyopathy or other cardiomyopathy
- Not: Left atrial enlargement
- Not: Aortic regurgitation or insufficiency, of any severity
- Not: Regurgitation of any valve, moderate or higher
- Not: Structural abnormalities, such as a dilated ventricle or atria
Not every exam
An annual echo is not required for each FAA exam for this CACI.
The worksheet's criteria
Not for
- Not: Secondary MR or functional MR due to coronary heart disease, MI, ischemic disease or cardiomyopathy
No history of
- Not: Connective tissue disorder, such as Marfan's or Ehlers-Danlos
- Not: Lung disease: COPD (moderate or higher), or pulmonary HTN
- Not: Other cardiac disease, such as congestive heart failure, ischemia or other valve disease
The worksheet's notes
If any valve other than mitral was involved, the information must be submitted to the FAA for review.
If warfarin (Jantoven) or other anticoagulation (other than ASA) is required for a cardiac condition, the examiner should defer.
Show the FAA's words: the CACI worksheet's criteria for Mitral valve repair
- Mitral valve repair surgery 5 or more years ago, for primary mitral valve disease
FAA criterion: the pilot had mitral valve repair surgery 5 or more years ago for primary mitral valve disease (not secondary MR or functional MR due to coronary heart disease, MI, ischemic disease, or cardiomyopathy).
The airman had Mitral Valve Repair surgery 5 or more years ago for primary mitral valve disease (not secondary MR or functional MR due to coronary heart disease, MI, ischemic disease, or cardiomyopathy). [ ] Yes
- What the treating cardiologist's progress note verifies
FAA criterion: the treating cardiologist's current, detailed clinical progress note verifies that the pilot is asymptomatic and stable; has no other current cardiac conditions; has not developed any new conditions, arrhythmias, or complications that would affect cardiac function; requires no more than a routine annual follow-up; and that no additional surgery is anticipated or recommended.
The treating cardiologist’s current, detailed Clinical Progress Note verifies: … Is asymptomatic and stable; … Has no other current cardiac conditions; … Has not developed any new conditions, arrhythmias, or complications that would affect cardiac function; … Requires no more than a routine annual follow-up; and … No additional surgery is anticipated or recommended.
- No history of the conditions the worksheet lists
FAA criterion: the pilot has no history of connective tissue disorder (Marfan's or Ehlers-Danlos, etc.); lung disease: COPD (moderate or higher), or pulmonary HTN; or other cardiac disease (e.g., congestive heart failure, ischemia, other valve disease, etc.).
The airman has NO history of: … Connective tissue disorder (Marfan’s or Ehlers-Danlos, etc.); … Lung disease: COPD (moderate or higher), or pulmonary HTN; or … Other cardiac disease (e.g., Congestive Heart Failure, ischemia, other valve disease, etc.)
- The most recent echo, performed within the last 24 months
FAA criterion: the most recent echo, performed within the last 24 months, shows mitral valve regurgitation (if present) classified as mild, and no other abnormalities on echo such as a dilated aorta greater than 4 cm; hypertrophic cardiomyopathy or other cardiomyopathy; left atrial enlargement; aortic regurgitation/insufficiency (any severity); regurgitation of any valve moderate or higher; or structural abnormalities (dilated ventricle, atria, etc.).
The most recent echo was performed within the last 24 months shows: … Mitral valve regurgitation (if present) is classified as mild; … No other abnormalities on echo such as: … Dilated aorta greater than 4 cm; … Hypertrophic cardiomyopathy or other cardiomyopathy; … Left Atrial Enlargement; … Aortic regurgitation/insufficiency (any severity); … Regurgitation of any valve moderate or higher; or … Structural abnormalities (dilated ventricle, atria, etc.)
- An annual echo is not required for each FAA exam
The worksheet notes that an annual echo is not required for each FAA exam for this CACI.
An annual echo is not required for each FAA exam for this CACI.
- If any valve other than mitral was involved
The worksheet notes that if any valve other than mitral was involved, the information must be submitted to the FAA for review.
If any valve other than mitral was involved, the information must be submitted to the FAA for review.
- If warfarin or other anticoagulation is required for a cardiac condition
The worksheet notes that anticoagulation is not routinely required for mitral valve repair, and that if warfarin (Jantoven) or other anticoagulation (other than ASA) is required for a cardiac condition, the examiner should defer.
Anticoagulation is not routinely required for mitral valve repair. If warfarin (Jantoven) or other anticoagulation (other than ASA) is required for a cardiac condition, the AME should defer.
If the examiner defersFAA review
The table's row B is a repair less than 5 years ago, or any of the co-morbid conditions the table lists. After a 3-month recovery period, the table lists what is submitted to the FAA for review, and it marks the row DEFER.
What the FAA lists to send
- Item 1. The hospital admission history and physical.
- Item 2. The operative report or surgical report.
- Item 3. The hospital discharge summary.
- Item 4. A current status report from the treating cardiologist, which should describe the type of repair, any complications, the current treatment needed, and the follow-up plan.
- Item 5. A list of medications and side effects, if any.
- Item 6. Cardiac testing performed after the 3-month recovery period and within the last 90 days: a 24-hour Holter, an electrocardiogram (ECG) and an echo.
- Item 7. Other imaging reports, if any, for studies performed by the treating cardiologist (for example a cath, CTA or MRA).
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's row B is a repair less than 5 years ago, or any of the co-morbid conditions the table lists. After a 3-month recovery period, the table lists what is submitted to the FAA for review, and it marks the row DEFER.
Less than 5 years ago OR Any of the co-morbid conditions below* … After a 3-month recovery period submit the following to the FAA for review: … DEFER Submit the information to the FAA for review.
What the FAA lists to send
- Item 1
The hospital admission history and physical.
Hospital admission history and physical;
- Item 2
The operative report or surgical report.
Operative report/surgical report;
- Item 3
The hospital discharge summary.
Hospital discharge summary;
- Item 4
A current status report from the treating cardiologist, which should describe the type of repair, any complications, the current treatment needed, and the follow-up plan.
Current status report from the treating cardiologist which should describe the type of repair, any complications, current treatment needed, and follow up plan;
- Item 5
A list of medications and side effects, if any.
List of medications and side effects, if any;
- Item 6
Cardiac testing performed after the 3-month recovery period and within the last 90 days: a 24-hour Holter, an electrocardiogram (ECG) and an echo.
Cardiac testing performed AFTER the 3 month recovery period and within the last 90 days: 24-hour Holter; Electrocardiogram (ECG); Echo; and
- Item 7
Other imaging reports, if any, for studies performed by the treating cardiologist (for example a cath, CTA or MRA).
Other imaging reports (if any) for studies performed by the treating cardiologist (e.g., Cath, CTA, or MRA).
After the FAA decides
The table says follow-up issuance will be per the pilot's own authorization letter.
Show the FAA's words: after the FAA decides
Follow up Issuance Will be per the airman’s authorization letter
At later exams
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
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.
The table's note to the pilot
On the row that goes to the worksheet, the table tells the pilot to take the CACI worksheet to the cardiologist so they can fully address the FAA requirements.
Show the FAA's words: good to know, 2
Note to pilot: Take the CACI worksheet to your cardiologist so they can fully address the FAA requirements.
When the cardiac tests are done
In row B, the cardiac testing is performed after the 3-month recovery period and within the last 90 days.
Show the FAA's words: good to know, 3
Cardiac testing performed AFTER the 3 month recovery period and within the last 90 days: 24-hour Holter; Electrocardiogram (ECG); Echo; and
Residual regurgitation counts as co-morbid
Residual mitral valve regurgitation listed as moderate or higher on cardiac echo is one of the table's co-morbid conditions. Row B, which the table marks DEFER, names the co-morbid conditions.
Show the FAA's words: good to know, 4
Residual Mitral valve regurgitation listed as moderate or higher on cardiac echo. … Less than 5 years ago OR Any of the co-morbid conditions below* … DEFER Submit the information to the FAA for review.
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.
- Open to print: CACI – Mitral Valve Repair Worksheet, a PDF at the FAA, in a new tab
- Mitral Valve Repair Disposition TableOpen to print: Mitral Valve Repair Disposition Table, a PDF at the FAA, in a new tab
FAA review
- 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.