dilatation.doc

Case Report Manometric findings in dysphagia secondary to left atrial dilatation Giant, cyclic midesophageal pressure waves occurring with every heart beat Mitchell?S.?Cappell1 ? (1)? Gastrointestinal Motility Laser Endoscopy Unit, Division of Gastroenterology, Department of Medicine, University of Medicine of New Jersey, Robert Wood Johnson (Rutgers) Medical School, 08903-0019?New Brunswick, New Jersey Summary??A 26-year-old male with left atrial dilatation because of severe mitral stenosis presented with dysphagia and weight loss. Esophagogastroduodenoscopy revealed transmitted mural pulsations occurring at the frequency of the peripheral pulse and a compressed lumen in the midesophagus. Esophageal manometry revealed in the midesophagus a high-pressure zone with normally transmitted peristaltic waves through this region. Superimposed on the elevated baseline pressure in this zone were cyclic pressure waves occurring one-for-one with the QRS complex of the electrocardiogram. The midesophageal high-pressure zone and cyclic pressure waves are explained by pulsatile compression by the left atrium. Proximal and distal to this zone, the baseline esophageal pressure was normal, with no pressure oscillations present. This is the first direct manometric evidence that this dysphagia is due to mechanical obstruction from extrinsic compression and not due to dysmotility from esophageal nerve compression and injury by the dilated left atrium. This mechanism was previously supported by indirect radiographic evidence. Key words??dysphagia?-?left atrial dilatation?-?cardiomegaly?-?mitral regurgitation?-?mitral stenosis?-?mitral valve disease?-?rheumatic heart disease?-?manometry?-?esophageal motility References 1.Bloomfield A: Dysphagia with disorders of the heart and great vessels. Am J Med Sci 200:289–299, 1940 2.Channer KS, Bell J, Virjee JP: Effect of left atrial size on the oesophageal transit of capsules. Br Heart J 52:223–227, 1984 3.Morgan AA, Mourant AJ: Left vocal co