President Clinton Set for More Surgery

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President Bill Clinton will head back to a New York hospital on Thursday for more surgery. He will have fluid and scar tissue removed from his left chest cavity.

This follows a successful quadruple bypass heart surgery on Sept. 6, 2004 after imaging tests showed up to 90 percent atherosclerotic blockage (search) in several arteries to the heart.

The scar tissue and fluid developed as a result of inflammation; this prompted the lower lobe of his left lung to collapse, says a statement on the Clinton Foundation’s web site.

The American Heart Association says that about 5 to 10 percent of people develop fluid in their chest after heart bypass surgery.

Most of the time, the body takes care of the fluid, says Hartzell Schaff, MD, professor of surgery, Mayo Clinic, in Rochester, Minn. Less than one percent of those patients require additional surgery to correct it.

It’s not an emergency situation, but the former president has had “some discomfort in recent weeks,” says the Clinton Foundation statement, adding that Clinton “has otherwise been in very good condition, recently passed a stress test, and is walking up to 4 miles a day near his home in Chappaqua, N.Y.”

The problem doesn’t always require surgery, says David Jones, MD, chief of general thoracic surgery at the University of Virginia Health System. “Most times, we are able to drain the fluid without surgery,” says Jones, a spokesman for the Society of Thoracic Surgeons.

“But when you don’t get in early enough, it progresses. It starts as a fluid, then it gets a consistency like Jell-O, and then it causes a fibrous buildup on the lungs, which looks like an orange peel,” says Jones.

Low-Risk Procedure

The procedure, called decortication (search), carries a low risk and is occasionally needed after open-heart surgery, says the statement. It is a well-recognized complication of open heart bypass surgery.

Decortication refers to a surgical procedure done to free a fibrous capsule that has formed around the lung. In some conditions, such as after an episode of bleeding in the chest, a space that exists between the lung and the outer ribs can fill with fluid.

This fluid can thicken, eventually solidifying and forming scar tissue around the lung. Scar tissue can entrap the lung and cause breathing problems.

The condition isn’t very common, but it can be painful, says Jones. Without good pain control, patients may avoid coughing to clear the lungs or taking deep breaths because of the pain. “That begins the cycle,” says Jones.

The surgery works to remove scar tissue freeing the lung so it can function normally.

Decortication surgery requires general anesthesia and will be done either through a small incision in the chest wall or with a video-assisted thorascope inserted between the ribs, says the statement. The surgery will be done at New York Presbyterian Hospital/Columbia University Medical Center, where Clinton’s bypass was performed.

"The risks of President Clinton's first surgery were very low — less than 2 percent risk of death. The risk of this surgery is even lower — less than 1 percent," Schaff says. That risk is primarily related to the small risk that is present any time an individual has general anesthesia.

Clinton Expected to Resume Normal Schedule

Clinton is expected to spend three to 10 days recovering in hospital and later resume his work “without limitations,” according to the statement.

Politics aside, people may want to take a cue from the former president and see their doctor when health concerns arise. “Seek treatment at the first sign of lung pain after surgery,” says Jones. “The condition can be confirmed with X-ray.”

Had Clinton not seen his doctor when he experienced chest pain and shortness of breath last fall, his story may have unfolded differently.

Heart Disease Primer

President Clinton has fared well after his surgery. Many Americans aren’t as fortunate. Heart disease is a leading killer in the U.S.

Never hesitate to get a medical opinion if you notice symptoms such as:

—Shortness of breath

—Palpitations (irregular heart beats, skipped beats, or a “flip-flop” feeling in the chest)

—A faster heartbeat

—Weakness or dizziness



—Chest pain

If you’re not facing an immediate crisis, it’s to your benefit to get your blood pressure checked, reach a healthy weight, quit smoking, and lead an active life. Those steps — combined with medications, if needed — can go a long way towards safeguarding your heart.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

With reporting by Peggy Peck.

SOURCES: Clinton Foundation, “Statement: President Clinton To Undergo Medical Procedure.” WebMD Medical News: “Former Pres. Clinton Recovering From Heart Surgery.” News release, Amercican Heart Association.