Correspondence

In contrast with intrinsic atrial abnormalities, such as thrombus or myxoma, extrinsic masses move asynchronously with the atria.7-10 The esophagus can be identified by the echocardiographic appearance of air contrast during the ingestion of liquid containing carbon dioxide.7-10 Transesophageal echocardiography also may be useful for the identification of masses adjacent to the LA.

This case highlights achalasia as a rare but reversible cause of congestive heart failure because of extrinsic left-heart compression. A previous report has shown that echocardiography is a useful method for monitoring the treatment of decompensated esophageal achalasia.11 We also recommend echocardiography as a monitoring tool, in conjunction with a CT.

This is the first case report to demonstrate the value of TEE to rapidly identify LA obstruction due to surgical maneuvering of a food-filled esophagus with subcostal retractors. Although case reports have described posterior mediastinal masses diagnosed by echocardiography, none were diagnosed intraoperatively by TEE due to achalasia.1,2 In limited studies, TEE has been shown to be comparable to computed tomography or magnetic resonance imaging in diagnosing compression of cardiac chambers by posterior mediastinal masses, but only TEE can be used intraoperatively.3