In these patients, pulmonary plethora, left ventricular enlargement, or a continuous high frequency murmur under the left clavicle may suggest the diagnosis. The chest X-ray may show the ductus as a convexity between the aorta and the pulmonary artery. Cardiac catheterization is always indicated. These people may qualify for aviation. Large shunts require surgery, and the decision to pursue a career in aviation should be deferred until at least one year postsurgery.
Cardiac catheterization is necessary for full evaluation.
Since normal right ventricular pressures are mandatory for military aviation, individuals with this uncorrected malformation are generally disqualified. Surgery with near normal postoperative pressures is associated with excellent results, but, again, the small arrhythmia risk usually disqualifies the individual from an aviation career. Congenital aortic stenosis, though often with a more benign prognosis than its rheumatic counterpart, still has a risk of eventual myocaridal decompensation and arrhythmias and is therefore unacceptable for aviation. Though the initial clinical course is benign and asymptomatic, leaflet thickening invariably occurs by age 40 with later progression of calcifications and stenosis. For this reason, individuals with bicuspid aortic valves should be evaluated for any evidence of an increased gradient across the aortic valve, or left ventricular hypertrophy by echocardiography and doppler study.