Background <p>The use of transesophageal echocardiography (TEE) after esophagectomy remains controversial. Herein, we describe a case in which TEE use was safe and effective during cardiac surgery after esophagectomy with retrosternal gastric tube reconstruction.</p> Case presentation <p>A 71-year-old man, who had undergone esophagectomy with retrosternal gastric tube reconstruction, was scheduled for removal of a left atrial myxoma via right anterior thoracotomy under cardiopulmonary bypass. A multiplane TEE probe was smoothly inserted into the gastric tube, providing echocardiographic images similar to those acquired by transthoracic echocardiography via the parasternal and subcostal windows. TEE monitoring helped confirm the positions of the devices placed in the great vessels, tumor location, absence of residual air or leakage, and normal heart function. No complications related to the TEE were observed.</p> Conclusions <p>Intraoperative TEE monitoring is a feasible option even in patients who have undergone esophagectomy with retrosternal gastric tube reconstruction.</p>