Follow-Up Surgery Set for Clinton

Former President Clinton will undergo surgery this week to remove fluid and scar tissue from his chest cavity, a rare complication resulting from Clinton’s heart bypass surgery six months ago, his doctors said Tuesday.

Clinton, 58, is scheduled to have surgery Thursday at New York-Presbyterian Hospital/Columbia University Medical Center, and will spend three to 10 days recuperating there. Physicians treating him said he probably would have an uneventful recovery and resume a normal life.

“This is an elective process,” Dr. Allan Schwartz, chief of the hospital’s cardiology department, said at a news conference. “This is not an emergency.”

The former president said he first experienced discomfort several weeks ago, when he noticed that he was getting winded after finishing his usual 4-mile daily cardiac walk near his home in Chappaqua, N.Y. He also experienced an increase in pressure on the left side of his chest, which left him short of breath.

The procedure to relieve these conditions, known as decortication, is considered to be medically routine and will take one to three hours, doctors said. Clinton will be put under general anesthesia.

“I feel fine,” the former president told reporters at a White House news conference, where he appeared with former President George H.W. Bush to discuss their recent visit to Southeast Asia to promote private fundraising for tsunami relief.

Clinton said that he would be playing golf today in a tournament in Hobe Sound, Fla., north of West Palm Beach, to raise money for tsunami victims a day before he enters the hospital. The surgery “will knock me out of commission for a week or two, but it’s no big deal,” he said.

The former president’s discomfort results from “an unusual condition where you get inflammation after heart surgery,” said Dr. Jignesh Patel, an assistant professor of cardiology at UCLA. “As a result ... you keep accumulating fluid in the chest cavity. Some scarring occurs as well, so the lung never gets to expand fully.”

In decortication surgery, doctors drain the fluid and remove the scar tissue to allow the lung to function normally and to prevent further fluid buildup.

Surgeons typically start by making a small incision, about the width of a pinkie finger, between the ribs at the base of the chest. This allows some fluid to drain from the chest, and doctors can use a suction catheter to remove additional fluid. Altogether, more than a pint of fluid can be drained.

Next, doctors insert a flexible fiber-optic camera called a thoracoscope to look around inside the chest cavity and gauge the size and shape of the scar tissue.

After that, surgeons typically make another small incision about 3 or 4 inches away to serve as a “utility port” for scissors, graspers and other instruments needed to cut away the scar, said Dr. Vaughn Starnes, a cardiothoracic surgeon at USC University Hospital in Los Angeles.

Pieces of scar tissue can be removed through the incision, and 70% to 80% may have to be removed for the procedure to be considered a success, Starnes said.

Sen. Hillary Rodham Clinton (D-N.Y.) said she would be with her husband when he went to the upper Manhattan hospital for surgery, adding: “We have no reason to believe it’s anything other than a routine procedure that has to be taken care of.”

The former president has maintained a whirlwind schedule since his Sept. 6 bypass surgery, including stops during the presidential campaign with Democratic nominee Sen. John F. Kerry of Massachusetts and public events linked to the opening of Clinton’s presidential library in Little Rock, Ark.

James Carville, a former Clinton political aide and consultant, told CNN that his former boss “has a very hectic schedule, and he always seems to be doing fine.”

Several observers, however, said Clinton had looked run-down during some recent public events, including several he made last week in Los Angeles.

“I did think he seemed tired,” said Los Angeles radio host and executive producer Warren Olney, who interviewed the former president Wednesday and Thursday nights after speeches Clinton delivered at the Dorothy Chandler Pavilion as part of a speaker series.

Olney, who said Clinton seemed to be more lively the second night, added that “it had no impact on his ability to answer any given question with an extraordinary amount of detail and analysis.... My understanding is that he had just arrived back from this tour of Asia, and had gone to 10 countries in 13 days.”

Doctors said Tuesday that the president’s travels had not contributed to his condition. Indeed, they said they had known about Clinton’s condition before he went to Southeast Asia, and had not discouraged him from making the trip. They did, however, recommend that he have the surgery soon after returning.

Dr. Joshua Sonnet, also with the hospital surgical team, said that the operation was “low risk,” and that it was highly unlikely that the medical problem would recur.

Although the former president recently passed a stress test, X-rays determined that he had the buildup of fluid and scar tissue around his heart, doctors said.

“And it was the combination of these things that led to our decision to recommend the procedure,” Schwartz noted.

Clinton is expected to make a full recovery, but Dr. Craig Smith -- who led the team that performed quadruple bypass surgery on the former president in September -- acknowledged that this kind of surgical procedure after a bypass is rare.

“Based on my experience, with about 6,000 similar cases ... we see an outcome requiring this procedure in some fraction of 1% of all cases,” Smith said.

The former president said he expected to resume a full schedule four weeks after the operation. At Tuesday’s White House news briefing on tsunami relief, former President Bush joked that Clinton showed no lack of energy during their Asian tour.

“You should have seen him going, town to town, country to country, the Energizer Bunny here, it killed me,” Bush said.

Earlier, President Bush, meeting with the two former presidents, joked about Clinton: “President Bush and President Clinton are going to be playing golf tomorrow. That goes to show how sick he is.”

Getlin reported from New York and Kaplan from Los Angeles. Times staff writer Edwin Chen in Washington contributed to this report.

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(BEGIN TEXT OF INFOBOX)

Surgery details

The former president’s medical procedure will remove a buildup of fluid and scar tissue that has partially collapsed his left lung. The condition resulted from a quadruple bypass surgery he underwent in September.

Cut, drain, view

First incision drains fluids.

After fluid has drained, a camera called a thoracoscope is inserted to view the scar tissue.

Remove scar tissue

Second incision allows scar tissue to be removed piece by piece with surgical scissors. Camera allows doctors to see.

Expand lung

A chest tube is inserted to suck out additional fluids and to create a vacuum in chest cavity to help lung expand. Incisions are closed.

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Source: Times research