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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
[+] Article and Author Information

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).


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;123(2):114-116. doi:10.7326/0003-4819-123-2-199507150-00006
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Extrinsic left atrial compression is an uncommon source of hemodynamic compromise [1] that can be caused by many mediastinal structures, including bronchogenic cysts [23], 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.

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Figure 1.
Compression and relief of compression of the left atrium in a 60-year-old man. Top.Bottom.

Severe compression of the left atrium 5 days after transhiatal esophagectomy, shown by transthoracic echocardiography in the four-chamber view. Relief of compression after evacuation of the stomach. LA = left atrium; LV = left ventricle.

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Figure 2.
Obliteration of the left atrium and relief of left atrial compression. Top.Bottom.

Almost complete obliteration of the left atrium by an extrinsic mass in a 94-year-old woman with a known hiatal hernia. Relief of left atrial compression after removal of 800 mL of fluid from the stomach. Ao = aorta; LA = left atrium; LV = left ventricle.

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