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Hemodynamically Significant Extrinsic Left Atrial Compression by Gastric Structures in the Mediastinum
- Syed T. Raza;
- Sandip K. Mukherjee;
- Peter G. Danias;
- Jame Abraham;
- Kevin M. Johnson;
- Milton J. Sands;
- Morgan S. Werner; and
- David I. Silverman
- From the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut. Requests for Reprints: David I. Silverman, MD, Cardiology L3108, University of Connecticut Health Center, Farmington, CT 06030. Grant Support: In part by a Young Investigator Award from the Patrick and Catherine Weldon Donaghue Foundation (Dr. Silverman).
Extrinsic left atrial compression is an uncommon source of hemodynamic compromise [1] that can be caused by many mediastinal structures, including bronchogenic cysts [2, 3], carcinoma [4], lymphoma [5], thymoma [6], aortic aneurysm [7], and diaphragmatic hernia [8]. To date, however, few cases of gastric structures (stomach, esophagus, or both) causing hemodynamically significant left atrial compression have been reported [9]. We describe three cases of extrinsic left atrial compression by the stomach that caused simultaneous hypotension and congestive heart failure.
Case Reports
Patient 1
A 60-year-old man with squamous cell carcinoma of the hypopharynx had elective transhiatal esophagectomy, which was complicated by a non-Q wave myocardial infarction. Echocardiography showed inferoapical hypokinesis with normal chamber dimensions. The patient's condition stabilized, and nasogastric suction was discontinued on the fourth day after surgery. One day later, however, the patient became dyspneic and diaphoretic. His systolic blood pressure was 85 mm Hg by palpation, his heart rate was 110 beats/min, and his respiratory rate was 36 breaths/min. Chest examination revealed rales over the lower half of both lung fields. An arterial blood gas test showed hypoxemia and an arterial-alveolar gradient of …
