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J Thorac Cardiovasc Surg 2005;129:212-214
© 2005 The American Association for Thoracic Surgery

Brief Communications

Transsternal transpericardial approach for acute descending necrotizing mediastinitis

Franco Stella, MD, PhDa, Francesco Petrella, MDa,*

a Department of General and Thoracic Surgery, "S. Orsola–Malpighi" Hospital, University of Bologna, Bologna, Italy

Received for publication March 5, 2004; accepted for publication April 6, 2004.

* Address for reprints: Francesco Petrella, MD, Department of General and Thoracic Surgery, "S. Orsola–Malpighi" Hospital, University of Bologna, Bologna, Italy (E-mail: fpetrella@libero.it).

The first 20% of the full text of this article appears below.

Acute mediastinitis is a severe infection of mediastinal connective tissue between the 2 pleural cavities and surrounding median thoracic structures. It is usually caused by esophageal perforations or poststernotomy infections.1 Descending necrotizing mediastinitis (DNM) is one of the most dangerous mediastinal infections and is caused by odontogenic or cervicofascial infections or cervical trauma. Infection descends along the deep cervical fascial space, causing cellulitis, necrosis, and abscess formation in the mediastinum, leading to sepsis. Hasegawa and coworkers2 proposed classifying DNM into 3 groups on the basis of infection extension: type I, infection localized in the upper mediastinum above the tracheal bifurcation and not always requiring aggressive mediastinal drainage; type IIA, infection extending to the lower anterior mediastinum; and type IIB, infection extending to the anterior and lower posterior mediastinum and demanding complete mediastinal drainage.

Only small series of DNM have been reported in recent literature, with mortality rates of between 25% and 40% in different series.3 Toilette, debridement, drainage of infected fluid collections, and necrotic tissue exeresis are the surgical gold standard therapy, but the best surgical approach for this operation remains controversial.

We report a case of acute DNM after left parapharyngeal abscess that was treated through a transsternal transpericardial approach, which offered a very good surgical field and allowed radical drainage and necrosectomy of infected tissue. The postoperative course was uneventful, and the patient was discharged 22 days after the operation.


   Clinical summary
 
A 76-year-old man was admitted to the emergency department because of 2 days . . . [Full Text of this Article]






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