By Robert Bazell Chief science and health correspondent
NBC News
updated 3/10/2005 2:53:52 PM ET 2005-03-10T19:53:52

Former President Clinton underwent follow-up surgery Thursday to remove fluid and scar tissue from his left lung after his quadruple heart bypass six months ago. While fluid buildup in the chest cavity is not uncommon after bypass surgery, most of the time the body reabsorbs the fluid. In Clinton's case, scar tissue formed around a part of his lung, causing him discomfort and shortness of breath.

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NBC New's chief science correspondent Robert Bazell reports on the procedure that doctors performed during Clinton's surgery.

Doctors say the development of scar tissue on the lung is a rare complication of heart bypass surgery. What happened in Clinton's case?
It’s rare but not unknown. Because one of the blood vessels that’s used to revasculerate [restore blood supply to] the heart during the bypass surgery is taken from inside the chest wall near the lining of the lungs, for reasons they don’t understand, scar tissue and subsequently fluid builds up in that space. That’s what’s happened in this case.

What did doctors do during the procedure?
The first thing they’ll do is prepare him for anesthesia, which in this case takes longer than in many other procedures because they have to deflate one of his lungs. When they do that they want to make sure the other lung is properly mechanically ventilated. He'll be on a mechanical ventilator. The anesthesia includes an epidural [a local anesthesia] near the spine. He’ll get that when he’s still conscious. Then they'll put him to sleep during the general anesthesia to get on with the operation. The operation will take anywhere from one to four hours, depending on which of the two options they choose.

The first option is what’s called a thoracoscope. We’ve all heard of arthroscopic surgery, now there are all kinds of surgery where they insert tubes with fiber optic video cable as well as tiny instruments into the body. They start with two tubes between the ribs, so it doesn’t require any more trauma to the rib cage. The main thing they’re trying to get rid of is a film that’s built up, pieces of inflammation around the lung. The doctors describe it like a skin around an onion. They have to take that off. That’s the delicate part because obviously you don’t want to puncture the lung.

They have to be very careful that they get all the scar tissue. If they are able to get it all with the thoracoscope, his recovery period will be very brief and he could be home in two or three days. If they determine they can’t get it all out with the thoracoscope, they’ll make an incision where they put in spreaders and spread the bones apart. That’s not even such a big deal except in September Clinton did have his chest cracked , so his rib cage is subject to more trauma.

Then they’ll operate with standard surgical instruments to make sure they get it all. If they go with the second option, the operation could last up to four hours and recovery time would be longer because it’ll be more of a serious incision.

Is it a routine procedure?
This is a low-risk surgery. It’s not like the heart bypass operation where they actually have to stop his heart and put him on a machine that takes over the oxygenation of the blood. But all operations are risky, particularly operations that involve anesthesia.

There’s always the possibility that the anesthesia could cause side effects or problems with bleeding. Everything is relative. It’s always best not to have surgery but he’s got to have it.

Clinton has been very active since his initial bypass surgery. Could he have done something to cause the complication?
No. It all seems like it’s a result of something that happened during the surgery. There’s nothing that he could have done to aggravate this. He never felt particularly perfect or good after the surgery. He didn’t seem to be recovering. Everyone noticed that he looked skinny and gaunt.

Should patients who have bypass surgery be more aware of the possibilities of this complication?
No. It’s such a rare thing that his doctor said he didn’t discuss it with Clinton. Maybe he should have. Dr. Craig Smith [chief of the Division of Cardiothoracic Surgery at New York-Presbyterian Hospital/Columbia University Medical Center] who did the initial surgery said he’s done 6,000 bypasses in his career and this is about the tenth time this has happened. This seems to be about the rate that it occurs after bypass surgery.

What will Clinton's recovery be like and will he have any limitations after the surgery on what he can do?
He should have absolutely none if he continues to follow a heart-healthy lifestyle. Many people have lived for many decades after heart bypass surgery and he should certainly. He seems healthy in every other way.

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