HEART OF THE MATTER
SEPTEMBER 23, 1996
Russian President Yeltsin is undergoing a second week of tests in a hospital in Moscow, where every day brings new rumors and revelations about his health. Elizabeth Farnsworth talks to a leading cardiac surgeon after a background report by Lawrence McDonnell of Independent Television News.
A RealAudio version of this NewsHour segment is available.
July 4, 1996
Deputy Secretary of State Strobe Talbott discusses Boris Yeltsin's election win.
Browse the Online NewsHour's Russian coverage.
LAWRENCE MC DONNELL, ITN: When American heart specialist Michael DeBaake flew into Moscow today, he refused to come into the operation facing the Russian president, other than to say he was, as ever, optimistic. That's more than could be said for one of his old students who turned up to meet him. Dr. Renat Achurin heads the team of surgeons who will operate on Boris Yeltsin. Last night on Russian television, he said it may be up to two months before his patient is strong enough to go into theater, and if he's thought too weak to operate on, then he won't go in at all. Ever since Boris Yeltsin announced he'd chosen to have bypass surgery to improve the blood supply to his heart, the secrecy that surrounded the true state of the President's health has quickly been replaced by a sense of alarm. Some doctors here now put his chances of surviving the operation at an even 50/50.
Just a week ago, they were talking of a 98 percent success rate. And today's suggested the President is capable of working on documents for just 15 minutes a day. In his recently staged television performances, he was clearly having trouble with even some of those documents. Boris Yeltsin is by no means the first Russian leader to carry on as head of state in poor physical health. When General Secretary of the Communist Party Constantine Chernenko was helped to the ballot box in 1983, he could hardly stand unaided. He died shortly after these pictures were taken.
Leonid Brezhnev fell seriously ill in 1974, and many of his close aides though him unable to rule the Soviet Union. In fact, he ruled for another eight years until his death. Towards the end, he was so heavily drugged it's now acknowledged he had little idea of what was going on around him. Vladimir Kryuchkov was head of the KGB when the Soviet Union collapsed five years ago. He was one of those who kept Brezhnev in charge. He told Channel 4 News that in the old days it was possible to keep leaders going because the system could cope, but that's not the case today.
VLADIMIR KRYUCHKOV, Former KGB Chief: (speaking through interpreter) Especially in the last few months it was difficult for Brezhnev to rule, but the system was effective. We had a team of advisers who were committed to keeping the state strong. Today there is no management. There is no tradition of rule. There is a total lack of control.
LAWRENCE MC DONNELL: As reports emerged that Boris Yeltsin has suffered a third heart attack ahead of the second round of presidential elections in July, there quickly calls for him to step down. The Communist runner-up in those elections, Gennady Zyuganov, argued that voters had been deceived. The president, he claimed, was incapacitated, and according to Russia's constitution, the prime minister should take over ahead of fresh elections. Mr. Zyuganov's deputy, Alexei Podberyozkin told me the opposition found it unacceptable that the country was being elected by non-elected officials in the president's name.
ALEXEI PODBERYOZKIN, National Patriotic Movement: Unfortunately, it was in our history many times when the czar or the president is ill or cannot fulfill all obligations from his side and some people are doing the politics while independently having behind their back the president's name. This situation really disturbs us.
LAWRENCE MC DONNELL: But Boris Yeltsin's staff don't believe their man is about to give out just yet.
Do you think Boris Yeltsin will resign under any circumstances?
VYECHELSLAV MILKONOV, Yeltsin: Well, I'm sure he will not. President Yeltsin is not a kind of person who is going to resign under any circumstances, especially if some people from their position will tell him to do so.
ELIZABETH FARNSWORTH: New information often hard to verify is, as I said, revealed almost daily about Boris Yeltsin's health. Over the weekend, his former press secretary said that besides heart trouble, the President also suffers from problems with his kidneys, liver, back, hearing, and with the blood vessels that supply his brain. And the surgeon who is slated to perform Yeltsin's bypass and who said Friday the President had a heart attack before the second round of the summer's presidential elections corrected himself yesterday. He said it was not an attack but unstable angina which did not damage the heart. Here to explain the surgery that Yeltsin is facing and the risks from his other health problems is Dr. Robert Jones, a cardiac surgeon and the chief medical officer for Duke University Hospital. Thanks for being with us, Dr. Jones.
DR. ROBERT JONES, Duke University Hospital: (Raleigh, N.C.) Thank you, Elizabeth.
ELIZABETH FARNSWORTH: Let's begin at the beginning. Please help us understand what is the nature of the heart trouble that Boris Yeltsin has.
DR. JONES: Well, none of us really know the exact problem from the reports we hear from the press we think that he has blockage in the coronary arteries that carry blood to the heart muscle.
ELIZABETH FARNSWORTH: If you--could you use the diagram that we have and explain what that is.
DR. JONES: Yes. The diagram shows the heart as a surgeon would see it looking through an open chest. The round portion is that which pumps blood up through the aorta to the body and the first blood vessels that come off of the aorta are the coronary arteries, and they carry blood to the heart muscle. And, as you can see illustrated, the hardening of the arteries caused by atherosclerosis has partially or totally blocked the arteries in the illustration. One of the important things about Mr. Yeltsin to know is how severely those arteries have blocked.
ELIZABETH FARNSWORTH: And you don't know that, right?
DR. JONES: No, I don't know, and I don't think anyone in the West does know.
ELIZABETH FARNSWORTH: Using the second diagram, explain what bypass surgery is. How does it work?
DR. JONES: It's really just a plumbing operation where you take natural tissues to use as new pipes, and route blood around those blockages. In this illustration, the two pipes used are pieces of vein that are harvested from the skin of the leg. Occasionally we use natural arteries in the chest wall, and these blood-carrying vessels then bring arterial or red oxygenated blood to nourish the heart. And these are sewn into the vessel below the area of blockage.
ELIZABETH FARNSWORTH: Dr. Jones, for an ordinary patient, somebody who needs a bypass but does not have a lot of other complications, how dangerous is the operation?
DR. JONES: We usually talk of risk in terms of percent, and a standard bypass in a patient Mr. Yeltsin's age would be about 1 percent risk. That would be out of 100 patients like him you would expect 99 to live. But that's assuming that he has no damage to his heart or that he doesn't have any other severe health problems.
ELIZABETH FARNSWORTH: And we should say he is 65.
DR. JONES: Yes, that's right.
ELIZABETH FARNSWORTH: Now, his doctor said Friday that he may have had a heart attack last summer, then corrected himself and said it was stenocardia, which I gather is a kind of angina. Could you explain that.
DR. JONES: Yes. That term in this country is called unstable angina, and it is simply chest pain that is irregular in its tempo and reflects the fact that the heart's not getting the blood that it needs, and the oxygen lack is the thing that causes the pain.
ELIZABETH FARNSWORTH: So a patient who had this problem in the summer would not have a much higher risk if he had an operation now?
DR. JONES: No, he would not. The big concern is whether unstable angina progresses to heart attack, which means that some of the heart muscle has actually been damaged irreversibly, and particularly if that damage involves the structure that supports the valves of the heart, it can raise the risk of surgery substantially.
ELIZABETH FARNSWORTH: And we just don't know about that either?
DR. JONES: No, we don't.
ELIZABETH FARNSWORTH: But what about the reports that the President, that President Yeltsin has other problems? Let's assume for a moment, which we don't know the facts exactly, but there is some evidence that he has--somebody has said he has liver problems. Would that raise the risk?
DR. JONES: Yes, it would. The liver is involved in making a number of proteins in the blood that aid clotting, and patients who enter surgery with a large amount of problem with their liver can be at a good deal higher risk.
ELIZABETH FARNSWORTH: What about kidney problems?
DR. JONES: Kidney problems also can raise the risk of surgery. I think we are speaking in the terms of two- to three-fold increase in risk if he has severe damage of either the kidneys or the liver.
ELIZABETH FARNSWORTH: And what about reduced blood supply to the brain?
DR. JONES: That's a concern for a stroke that might occur near the time of surgery. The same hardening of the arteries process and the arteries leading to the brain is the most common cause of stroke, and as one goes through the stress of surgery, uh, you can have an extra risk of stroke if you are known to have blockage in those arteries.
ELIZABETH FARNSWORTH: So let's assume for a moment that what his press secretary is right, that he has all three of those problems. What does that leave us with, the risks? What are the figures then?
DR. JONES: Well, one would really need to know how severe the problems were, but in general, you have about a twofold risk for each of those problems, and so that you could see that if he has some damage to his heart and has kidney, liver, and brain problems, that his risk could approach even 25 percent, where out of 100 patients like him, you would expect only 75 to live.
ELIZABETH FARNSWORTH: We heard in the report that some doctors in Moscow are saying a 50/50 chance. Does that seem a little high to you?
DR. JONES: That's a little high, but it depends, again, on how severe those disorders are of the other organs particularly.
ELIZABETH FARNSWORTH: What about the facilities in Moscow, can he get good treatment in the clinic where he's to be operated?
DR. JONES: Yes. That's the leading clinic in the Soviet Union and in Russia these days, and there are some excellent, well-trained surgeons there.
ELIZABETH FARNSWORTH: Even though they don't do as many surgeries as here? I've read that perhaps a hundred to a hundred and fifty of these surgeries I believe a year they do there as opposed to how many do you do?
DR. JONES: I do, uh, much more than that, and--
ELIZABETH FARNSWORTH: How many would you say you do a year, just out of--
DR. JONES: The average in this country for large centers is over a thousand and usually each surgeon will do around two hundred.
ELIZABETH FARNSWORTH: So is that a problem, that there aren't as many done?
DR. JONES: No. I think at that center there are very well trained surgeons. Throughout the rest of Russia and the former Soviet republics, uh, the expertise in coronary surgery is not as high as in this country, but there are excellent surgeons at that institution.
ELIZABETH FARNSWORTH: What about the problem of President Yeltsin's stature? And given the history of hiding health problems of Russian leaders, does the fear that a doctor might have treating somebody like President Yeltsin, can it affect his health or affect his work?
DR. JONES: Yes, it clearly can. One is always under a little pressure doing surgery, but when you're doing surgery on a very prominent individual, there's always the tendency to decrease your crispness of decision, to try not to make any decision that would have any risk and to be extra conservative, and that sometimes that can bring more risk than giving a patient the usual treatment that you would usually give for your standard patient.
ELIZABETH FARNSWORTH: This is something that is not limited to Russia. This is true here too, I suppose?
DR. JONES: That's true. It's been shown that some of our presidents in the past have had some very poor judgments made about their treatment.
ELIZABETH FARNSWORTH: So do you think that may be why they're delaying the surgery? Can you tell us anything about why surgery may be delayed? That's what the President--that's what doctor announced this weekend.
DR. JONES: I think that there is a strong concern to make the right decision, and I think that's why they've invited some prominent surgeons from this country to give them some advice. There's some consideration that he will have some extra testing, particularly non-invasive physiologic testing of the heart, and it seems that all those judgments are very reasonable.
ELIZABETH FARNSWORTH: Explain to us the difference in President Yeltsin's behavior. You'll see him dancing--and there's this famous image of him dancing during the presidential campaign, and really showing a lot of vitality, and then he's very ill, can hardly move the papers, as you saw in the tape. Is this typical of heart patients, or is this something about President Yeltsin?
DR. JONES: Heart patients that have very advanced heart disease cannot have enough blood supplying the needs of their body so that they can dance and appear very frisky as he did earlier. It's quite possible that he has gone into what we would call congestive heart failure, which fortunately is a reversible situation if his heart can be fixed. He does look very chronically ill on the videos that are supplied.
ELIZABETH FARNSWORTH: What about alcohol? How does alcohol ingestion affect a heart operation of this sort?
DR. JONES: Alcohol can have a direct depressing effect on the heart if it's used over many years. Additionally, the concern about his liver may be alcohol related, and if he has very severe liver disfunction, this represents one of his more major risks for cardiac surgery.
ELIZABETH FARNSWORTH: Well, Dr. Jones, thank you very much for being with us.
DR. JONES: Thank you, Elizabeth.