Clinton surgery like removing skin from onion

NEW YORK - 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.

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.

MORE FROM HEART HEALTH

Heart health Section Front

Heart disease to cost U.S. $503 billion in 2010 Blood pressure drug tainted with bits of metal FDA confirms benefit of Crestor in more people Body mass, waist size can predict heart disease 6 surprising heart attack triggers Hospitals speeding heart attack care, study says Study: Stifling anger at work can be dangerous ‘Super X-ray’ rules out heart attacks faster Permanent heart pump aids survival, study says FDA says Prilosec can block benefits of Plavix Heart health Section Front   Add Heart health headlines to your news reader: