President Clinton to Undergo a Procedure to Remove Excess Fluid Around His Lungs

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• KWAME HOLMAN:

  Former President Clinton didn't let the announcement that he's headed back into surgery interrupt his schedule today. He attended planned meetings in Washington for tsunami disaster relief.

  Meanwhile, his doctors at New York Presbyterian Hospital-Columbia medical center talked about the procedure, called decortication, they'll perform on Thursday to remove fluid and scar tissue from the former president's left chest cavity.

• SPOKESPERSON:

  The fluid buildup and compression has caused the president some discomfort in recent weeks. But he has otherwise been in very good condition, recently passed a stress test, and is walking up to four miles a day near his home in Chappaqua.

  The risk of the procedure is low. Once fully recovered, President Clinton is expected to resume his work without limitations.

• KWAME HOLMAN:

  The new surgery would correct a rare complication that arose from Mr. Clinton's quadruple bypass surgery last September.

  Since that surgery, the 58-year-old former president has been very active, presiding over the opening of his presidential library in Little Rock, Arkansas, in November.

  And more recently, President Clinton joined the first President Bush to help raise private funds for tsunami victims in South Asia.

  And the two former presidents toured the devastated region last month. President Clinton's doctors said they knew about his condition prior to that trip.

• SPOKESPERSON:

  I think the main thing that's driving the decision for surgery is that normal lung tissue is being compressed, and we don't want to leave him with compromised lung function.

• KWAME HOLMAN:

  At the White House today, Mr. Clinton said he and former President Bush will participate in a golf fund-raiser for tsunami victims tomorrow, before he goes into surgery on Thursday.

• BILL CLINTON:

  You know, I felt well enough to go to Asia to try to keep up with President Bush, and we're going to go play golf tomorrow, so I'm not in too bad of shape. I feel good about it.

• GEORGE H.W. BUSH.:

  You should have seen him going town to town, country to country — the energizer bunny here. He killed me. So this thing, whatever he's got, if it knocks you out, it hasn't gotten to him yet.

• KWAME HOLMAN:

  After his surgery, President Clinton is expected to remain in the hospital for three to ten days.

• GWEN IFILL:

  For more, we turn to Dr. Matthew Facktor, a cardiothoracic surgeon who performs the same type of surgery that President Clinton will undergo this week.

  He is a member of the Washington Institute of Thoracic and Cardiovascular Surgery, and serves on the faculty at the George Washington University Hospital.

  He has not been involved in President Clinton's care. Dr. Facktor, thank you for joining us.

• DR. MATTHEW FACKTOR:

  Thank you.

• GWEN IFILL:

  Explain for us as much as you can in the president's words, "This isn't a big deal." Explain to us in layman's language what it is.

• DR. MATTHEW FACKTOR:

  I think he's right. It is not really a very big deal.

  And essentially what has is happened is that after he has had his heart surgery, and of course I don't know any of the details of his specific care, but on occasion, we will see that there is some fluid buildup in the chest, not just around the heart but around the lungs, both on the right and the left sides.

  And that fluid can re-accumulate after time in some patients. And when that fluid re-accumulates, sometimes it's too much for the body to reabsorb it.

  And then as that fluid sits in the chest cavity around the lungs, for example, it congeals, it becomes like Jell-O, hot liquid Jell-O becomes a solid after a while.

  And then if it stays there for a continued period of time, it goes beyond the Jell-O phase and becomes almost like a concrete or at least something very difficult to remove.

  So I think they're trying to get ahead of that and remove it before that becomes a major problem. And that's essentially what is going on.

• GWEN IFILL:

  So how unusual is it for something like that to happen?

• DR. MATTHEW FACKTOR:

  Well, this condition is not terribly unusual because it arises from all kinds of different problems, not just heart surgery.

  But coming from heart surgery, it's pretty unusual. Especially if all of this fluid is gone after the time of surgery, and some period of time goes on after that, then it is relatively unusual to see this occur, yes.

• GWEN IFILL:

  You say it happens in other types of surgery as is well?

• DR. MATTHEW FACKTOR:

  Well, in other types of conditions. For example, a very advanced pneumonia that becomes a major problem can ultimately result in the same thing.

  Bleeding after some sort of chest trauma, if it's not drained and evacuated properly, given enough time, a same sort of problem occurs. Those are all much different, of course.

• GWEN IFILL:

  Right.

• DR. MATTHEW FACKTOR:

  But they're variations on the theme. And this is an instance where, in this, after heart surgery, where it's just not all that common because these things are sort of taken care of at the time of the initial surgery and they don't tend to come back.

• GWEN IFILL:

  Is there anything that you can — is this something that he would have noticed ordinarily? He said he just was feeling a little winded when he took his walks.

  A little discomfort, I think his doctors said, set in. Are those just normal warning signs when you've had something as major as quadruple bypass surgery you would check out?

• DR. MATTHEW FACKTOR:

  These things can arise with very little symptoms, unless they're really a major, major problem.

  So if they're something that's more minor than that, some shortness of breath, especially if you are doing extreme exertion, or walking long distances, those types of things.

  Otherwise you may not notice it so much so unless it is really, really a major, major problem. However, if there are some early signs, and this is seen on a chest X-ray or some other form of imaging of the chest, the earlier it is treated, the better because it will only get more difficult with more time.

• GWEN IFILL:

  Becomes even more concrete-like.

• DR. MATTHEW FACKTOR:

  Exactly.

• GWEN IFILL:

  You have performed these types of procedures before. What happens on Thursday when the president goes in for this surgery?

• DR. MATTHEW FACKTOR:

  Well, and I don't know exactly how they're going to proceed, but typically once the patient is in the operating room and asleep under general anesthesia, they are placed into a sideways position so that it's easier to work on the side of the chest.

  It sounds like we are talking about the left chest in this particular case.

• GWEN IFILL:

  Lower left lobe I think is what they described it as.

• DR. MATTHEW FACKTOR:

  Exactly — so sort of the lower half of the left chest, a small incision, maybe an inch, maybe a little smaller, maybe just a little bigger is made.

  And a video camera basically on an 18-inch sort of metallic rod is placed into the chest and the surgeon can see all around inside the chest.

  The lung is typically actually deflated so only the right lung, for example, is breathing during the time of the surgery so that the left lung is completely decompressed like an empty balloon.

  And it's much easier to manipulate and work on that lung. So the surgeon will look around with the video camera, looking on a video screen up near the ceiling and then make perhaps one or two, maybe three other incisions — typically one or two other incisions, small incisions, to allow the passage of another small instrument, tweezers, scissors, all these types of instruments, to do the actual work, sort of like the right and left hand with the camera right down the middle.

• GWEN IFILL:

  So they're actually watching all this on a screen theoretically. They're not spreading the chest or going in again like they did last time?

• DR. MATTHEW FACKTOR:

  That's correct. This will be actually a totally different area than where they were before. Instead of down the middle, it will be somewhere on the side of the chest.

  And just a small couple of incisions or three, something like that, and the ribs will not be spread so that that will minimize the pain after the surgery and shorten the recovery period.

• GWEN IFILL:

  They just scrape off then whatever they find and drain whatever they find? Is that what happens?

• DR. MATTHEW FACKTOR:

  Exactly. They'll find fluid or Jell-O or cement or some combination of those things, just to use some other terms.

  And sometimes it can be tricky because the lung is a balloon essentially, if you will. And if you can imagine having some pieces of cement on top of a balloon, when you go to peel it, you can actually damage the lung —

• GWEN IFILL:

  You could puncture the lung?

• DR. MATTHEW FACKTOR:

  Sure because they're so well adhered but there are lots of techniques that we use to prevent that. And generally speaking, this is not an issue.

  But just in terms of giving you an idea of the complexity of the surgery, that's what's involved. But with modern techniques, especially the video techniques, all of those things are minimized.

• GWEN IFILL:

  So theoretically, he comes out, there are a few stitches and then he is out of commission for how long?

• DR. MATTHEW FACKTOR:

  Well, every patient is different, but he will probably need to be in the hospital for a few days, maybe longer.

  And should be, as he said earlier today, really a week or two of a true kind of recovery period — not laying in bed but up and active — sore, certainly, hopefully not too sore, and then after that, can resume pretty much a normal life.

• GWEN IFILL:

  I heard the president or his doctor say today that he was in the 95th percentile of healthiness for men his age, 58 years old. How can you be that healthy and still need what's pretty serious surgery?

• DR. MATTHEW FACKTOR:

  Sure. Well, I don't know how they determined that and came up with the figures for him. And that's certainly very good news.

  But actually that is extra good news because even though he's had this issue with some fluid buildup, and again they're being proactive and aggressive and not letting it get worse, which is the right thing to do.

  Because he is in otherwise apparently, you know, good health, that means to me that the lung tissue and his heart, which now is sort of refreshed and had this surgery done on it, will be able to tolerate all this very well.

  And it's just that it can lead to more serious problems if that lung is more and more compressed by having this scar tissue that's just contracting and contracting on the lung.

• GWEN IFILL:

  Dr. Matt Facktor, thank you so much for your help.

• DR. MATTHEW FACKTOR:

  My pleasure. Thank you.