Key result
Contrast echocardiography distinguishes esophageal left atrial compression from vascular structures to guide decompression.
Why the study?
Extrinsic compression of the left atrium is a potentially life-threatening and unusual cause of congestive heart failure, with massive left atrial compression by a dilated esophagus in achalasia being rarely reported.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
May assist differentiation in rare achalasia cases; leaves open validation beyond single-patient experience.
Extrinsic compression of the left atrium is a potentially life-threatening but unusual cause of congestive heart failure. Achalasia is a motility disorder characterized by impaired relaxation of the lower esophageal sphincter and dilation of the distal two-thirds of the esophagus. We report only the third known case in the world literature of massive left atrial compression by a dilated esophagus in a patient with achalasia. The use of contrast echocardiography with perflutren protein-type A microspheres allowed for differentiation between a compressive vascular structure and the esophagus. This resulted in prompt treatment leading to hemodynamic stability after nasogastric decompression and Botulinum toxin injection at the gastroesophageal junction.
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Stoupakis et al. (2004) conducted a case report in Congestive heart failure due to massive left atrial compression by achalasia (n=1). Contrast echocardiography with perflutren protein-type A microspheres followed by nasogastric decompression and Botulinum toxin injection was evaluated on Differentiation of compressive esophageal vs. vascular structure and subsequent hemodynamic stability. Contrast echocardiography with perflutren microspheres differentiated esophageal left atrial compression from a vascular structure in 1 achalasia patient, guiding successful decompression.
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