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© St. Petersburg Times, published January 24, 2003
During his press conference Thursday, Sen. Bob Graham called himself a 66-year-old "fire horse, ready to get in the harness" of a presidential campaign.
The good news for the senator is that he probably will be able to do just that, despite facing major heart surgery next month.
Graham is to undergo replacement of an aortic valve that is both leaking back into his heart and is also slightly obstructed, according to Dr. John F. Eisold, attending physician for the U.S. Congress. The first condition is called regurgitation; the second is called stenosis.
After tests this week, Eisold wrote to Graham saying the time for a replacement had come: "While not an emergency, I would recommend undergoing surgery as soon as your schedule permits."
But doctors say there's no reason to put aside those Oval Office dreams.
"Absolutely he can return to normal," said Dr. Rao Musunuru, a cardiologist and president of the American Heart Association's Florida and Puerto Rico affiliate.
That's true even if "normal" means a grueling run for the presidency, agreed Dr. Hugh M. van Gelder, a cardiovascular and thoracic surgeon at Bayfront Medical Center and All Children's Hospital. "Sure," he said. "The whole idea is to get people better than they were before."
Heart valve surgery has become more common in the past decade. According to the American Heart Association, 58,000 heart valve surgical procedures were performed in the United States in 1991, and that number leaped to 87,000 in 2000.
"We do them day in and day out now," said van Gelder. "We do them in kids and we do them in 90-year-olds."
The heart has two sets of pumping chambers: The right-side chambers pump blood to the lungs, and the left side pumps blood to the rest of the body. The left side, therefore, does most of the work, pushing blood through the aortic valve at the junction of the heart and the aorta.
The aortic valve opens to allow blood to leave the left ventricle and closes to prevent blood from leaking backward into the ventricle.
"The valve undergoes a lot of stress and strain as the heart opens and closes," said Musunuru, and over the years it stiffens and develops calcium deposits. Normally the movement of blood through the heart is smooth and quiet, he said, but the deposits can cause "turbulence" in the blood flow, or murmurs, common in the elderly.
There are several choices patient and doctor must take into account when considering a replacement of the aortic valve.
The most straightforward approach, van Gelder said, is the one chosen by Graham -- replacement of the troublesome valve with a mechanical, or manmade one.
A mechanical valve probably will last the patient's lifetime, but blood tends to clot on it, and patients therefore must take blood thinners for the rest of their lives.
There are several types of "biological" valves to choose from, too, including one taken from a pig heart, and another made from material surrounding a cow heart. A biological valve does not require blood thinners, but it can't be expected to last more than 12 or 15 years.
In yet another procedure, the patient's pulmonary valve is moved to the aortic position, and a valve from a cadaver is used to take the place of the removed pulmonary valve, said van Gelder.
In general, once a decision is made to replace the valve, one type of valve is no more risky to implant than the other, according to Musunuru of the heart association.
"Aortic valve replacement is a common procedure that provides people with decades of healthy living," Eisold wrote to Graham. "While the surgery, hospitalization and recovery are inconvenient, you can expect to return to a full schedule without any difficulty."