Anterior transpericardial closure of a main bronchus fistula after pneumonectomy

A young woman sustained a penetrating wound to the right anterior chest during a vehicular accident. Septic complications led to emergency pneumonectomy followed by infection of the pleural space and disruption of the right bronchus closure. Her condition improved after creation of a pleural window for dependent drainage and gauze packing of the pleural space. Subsequently, the open bronchial stump was closed utilizing a transpericardial approach through a median sternotomy incision which permitted eventual closure of the pneumonectomy space without thoracoplasty. When the length of the bronchial stump permits its application, the transpericardial approach to postpneumonectomy bronchial fistula closure offers important advantages over conventional transpleural techniques.