Compression of vascular and airway structures can complicate transducer passage and manipulation during transesophageal echocardiography. This case describes hemodynamic compromise caused by compression of the posterior pulmonary venous confluence by a transesophageal echocardiography probe during intraoperative evaluation in an infant with supracardiac total anomalous pulmonary venous drainage. Careful hemodynamic and airway monitoring during transesophageal echocardiography is required in all patients, particularly during initial probe insertion and esophageal passage.