Left Atrial Compression After Laparoscopic Gastric Banding

Abstract

A 50-year-old woman was referred for cardiac assessment to rule out endocarditis. She reported a 1-week history of fevers, nausea, vomiting, and productive cough. Vital signs at the time showed a blood pressure of 130/80, a heart rate of 80 bpm, and a temperature of 38.8 C. She was diagnosed with left lower lobe pneumonia and gram-positive bacteremia. She had undergone a laparoscopic gastric banding in 2005 and was able to lose 180 lb from a baseline of 380 lb. She had regular follow-up for only the first year. Cardiovascular examination revealed normal S1 and S2 heart sounds, an S4 heart sound, and no murmurs. Transthoracic echocardiography showed a wellcircumscribed compressive echogenic mass posterior to the left atrium (Fig. 1). An electrocardiogram showed sinus rhythm and no left atrial enlargement. A computed tomographic scan revealed a dilated esophagus measuring 5 cm in dimension (Fig. 2). Her symptoms resolved on deflation of the gastric band by her general surgeon. Megaesophagus is a rare complication, affecting 1.9% of patients after gastric banding, with only a few cases of its echocardiographic manifestations reported. Recurrent aspi-