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Clinton to have surgery to remove scar tissue, drain fluid

WASHINGTON—Former President Clinton will have surgery Thursday to correct an uncommon but non-life-threatening side effect of heart-bypass surgery that has partially collapsed one of his lungs.

Doctors will peel away thick scar tissue—much like pulling a sticky label off paper—and drain excess fluid from the former president's pleura, which is a thin membrane of cells over his lung.

The thickening tissue compressed the lower part of Clinton's left lung, leaving him in slight discomfort for about a month, especially in his daily uphill walks, doctors said Tuesday.

"This is a relatively low-risk procedure and we expect full functional recovery in a limited amount of time," Dr. Joshua Sonett said at a news conference at New York Presbyterian Hospital/Columbia University Medical Center, where the operation will take place. It's where Clinton had his original surgery last September.

Clinton was at his old stomping grounds—the White House—on Tuesday, saying he was feeling OK.

"I feel fine," Clinton said in the White House Roosevelt Room, after meeting with President Bush and former President George H.W. Bush about tsunami relief. "It's no big deal. And you know I felt well enough to go to Asia to try to keep up with President Bush, and we're going to play golf tomorrow"—a fund-raiser for tsunami relief in Florida with pro golfer Greg Norman—"so I'm not in too bad a shape. I feel good about it."

Clinton—who'd been walking 4 miles a day, six or seven times a week, and passed a stress test recently—will be hospitalized for three to 10 days.

When Clinton underwent the coronary-bypass surgery, doctors used his mammary artery as a graft. To get that artery, they opened up the left pleura, which ultimately produced the scar tissue and fluid buildup.

Up to 89 percent of patients who undergo bypass surgery get minor fluid buildup, almost always over the left lung, according to medical journals.

"Usually it dissipates by itself," Dr. Lawrence Cohn, a Harvard Medical School professor of cardiac surgery, said Tuesday.

In one-tenth of 1 percent of the cases, usually about four months after surgery, the fluid doesn't go away and causes scarring and thickening of the pleura that becomes painful and presses on the lung.

Normally the pleura is about as thick as plastic wrap, but in these cases it's about as thick as five stacked dollar bills, said Dr. Richard Stein, the chief of cardiology at Brooklyn Hospital Center and a medical spokesman for the American Heart Association.

Why this happens is a mystery.

Clinton will be under general anesthetic for the surgery, which will involve a small incision. A thorascope with a tiny video camera will be inserted between his ribs, surgeons at New York Presbyterian said. The surgeon then will peel away the pleura in an operation that could take anywhere from 1 { hours to three hours, Stein said.

"It's like taking a sticky label off a piece of paper. You may have to cut it in certain spots," Cohn said.

The technique of peeling away the pleura "is one of the earliest operations ever," Cohn said. "They'll peel it off, then hopefully that lung will stick very tightly to that chest wall and that's the end of the story."

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(c) 2005, Knight Ridder/Tribune Information Services.

PHOTOS (from KRT Photo Service, 202-383-6099): BUSH

GRAPHIC (from KRT Graphics, 202-383-6064): 20050308 CLINTON surgery

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