Clinton Surgery Called Rare, But Not Risky

Doctors will remove fluid buildup following his bypass surgery

WEDNESDAY, March 9, 2005 (HealthDay News) -- The medical procedure that former President Bill Clinton will undergo on Thursday is to correct a rare, though not especially risky, complication of the heart bypass surgery he had six months ago, doctors say.

The procedure, called decortication, will remove scar tissue and a buildup of fluid around Clinton's left lung. The American Heart Association says that about 5 percent to 10 percent of heart surgery patients have some kind of fluid buildup in the chest after surgery, but less than 1 percent of those patients require additional surgery to correct it.

"Most of the time, the body reabsorbs the fluid but occasionally the fluid just sits there and can become like gelatin," said Dr. Virginia Litle, a thoracic surgeon at Mount Sinai Medical Center in New York City. "It can compress the lung so the lung isn't completely filling the chest cavity like it's supposed to when you breathe. If you're not using your lungs to their maximum potential, you can get shortness of breath."

The shortness of breath results because the fluid prevents the lungs from expanding fully, explaind Dr. Eugene Grossi, chief of cardiothoracic surgery at the New York Veterans Administration Hospital, and a professor of surgery at New York University School of Medicine. "There is fluid between the chest wall and the lung so not only can the lung not expand, but it is trapped," he said.

If the presence of fluid is chronic, scar tissue will also develop. In Clinton's case, the scar tissue also caused compression and collapse of the lower lobe of his left lung, doctors said.

Since undergoing quadruple bypass surgery at New York-Presbyterian/Columbia University Health Center in September, Clinton has complained of shortness of breath and some discomfort on his left side, The New York Times reported Wednesday.

Doctors at the same hospital took X-rays recently and recommended this procedure, according to the Times report.

Still, the 58-year-old former president has managed to walk four miles a day and tour areas of Asia devastated by the December tsunami. On Tuesday he was at the White House, and on Wednesday, he played golf in a Florida charity event for tsunami victims.

For the decortication procedure, surgeons will either make small incisions between the ribs to draw out the fluid or will use a video-assisted thoracoscope.

"More importantly, they will clean off the layer of scar tissue that typically forms on the surface of the lungs because of the fluid and allow the lung to expand up against the chest wall," Grossi said.

Although the procedure is considered minimally invasive, it will require general anesthesia and a hospital stay of three to 10 days, his doctors said.

"He will have tubes coming out of his chest to evacuate any fluid or air," Litle explained. "Those will come out in a day or two and once those are out, he should be able to leave the hospital."

The risk of death is less than 1 percent, the American Heart Association said, mostly related to the giving of anesthesia. And the condition is unlikely to recur, doctors said.

More information

Visit the American Heart Association for more on heart bypass surgery.

SOURCES: Eugene Grossi, M.D., chief, cardiothoracic surgery, New York Veterans Administration Hospital, director, cardiovascular research lab, and professor, surgery, New York University School of Medicine, New York City; Virginia Litle, M.D., thoracic surgeon, Mount Sinai Medical Center, New York City; The New York Times; American Heart Association statement
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