Mitral Regurgitation

Recommendation parameters for mitral regurgitation include the severity of the diagnosis and the presence of signs or symptoms. The development of symptoms, especially dyspnea, fatigue, orthopnea, and/or paroxysmal nocturnal dyspnea, is a marker of a poor prognosis, including an inability to perform driver tasks and increased risk for sudden cardiac death.

Waiting period

Minimum — 3 months if post-surgical commissurotomy

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver has:

• Mild or moderate mitral regurgitation if asymptomatic, normal left ventricular (LV) size and function, normal pulmonary artery pressure.
• Severe mitral regurgitation that is asymptomatic.
• Surgical mitral valve repair for mitral regurgitation, is asymptomatic, and has clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.

Recommend not to certify if:

The driver has mild, moderate, or severe mitral regurgitation and has:

• Symptoms.
• Less than 6 METs on Bruce protocol.
• Ruptured chordae or flail leaflet.
• Atrial fibrillation.
• LV dysfunction.
• Thromboembolism.
• Pulmonary hypertension.

Monitoring/Testing

The driver with:

• Moderate mitral regurgitation should have an annual echocardiography.
• Severe mitral regurgitation should have an exercise tolerance test and echocardiography every 6 to 12 months.

Follow-up

The driver should have an annual medical examination.

Mitral Regurgitation Recommendation Table (PDF)