Transesophageal Echocardiogram to the Rescue in Diagnosing Ascending Aortic Pseudoaneurysm: Comment

We read with great interest the article by Yu and Fabbro.¹  However, we found an error in that the labels (Co [suprasternal collection] and Ao [ascending aorta]) in right image A and B of the original article were all opposite. The reasons are as follows.

The shape of the ascending aorta in mid-esophageal ascending aortic short-axis view should always be round (fig. 1, blue circle) rather than oval (fig. 1, red circle). In the right image A and B, the inappropriately low Nyquist limit of 46.2 cm/s overestimated the flow velocity in cavity labeled Co might misguide the authors to regard the laminar flow in ascending aorta as turbulent flow in fluid collection.²  Besides, the proximal jet width widened steeply after the flow went through rupture site followed by filling the whole cavity labeled Co, which was unconventional. The simultaneous existence of red and blue (laminar flow), brighter color (turbulent flow), even black (no flow) in the color Doppler box, and the accelerated flow began from the opposite cavity wall of the rupture site in the cavity labeled Ao, were also illogical. Crucially, the images A and B were obtained by xPlane mode, and the flow direction should be from left (ascending aortic proximal site) to right (ascending aortic distal site) in the view (fig. 1B).³  Hence, the jet direction through narrow rupture site should be from upper left to lower right (fig. 1B), followed by the shunt widening gradually, and the red flow in the cavity labeled Ao might be due to the blood flow diverting direction toward the probe by the hit of the cavity wall.

In short, we suggest that the authors exchange the sites of labels Ao and Co in the right image A and B. Our viewpoint would be confirmed if the authors offer the video and spectral Doppler of the shunt in rupture site. This article would be more accurate and useful to readers with correct labels attached.

The authors declare no competing interests.