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

I thank Dr. Chen et al. for their comments¹  and for their interest in my article.²  After review of the images, I agree that the labels Co (pseudoaneurysm collection) and Ao (aorta) in the right imageA and B should be switched. Although Dr. Chen et al. bring up important points as to why the labels should be switched, I believe the main reason to switch the labels is that the pseudoaneurysm was anterior to the ascending aorta and should be in the far field or further from the probe.³  Below is the figure with the corrected labels. Their reason that in the mid-esophageal ascending aortic short-axis view the aorta should always be round does not always apply, especially in postcardiac surgery patients, which is a risk factor for pseudoaneurysm.⁴  Also, the recommended range for evaluating the aorta with color flow Doppler is a Nyquist of 50 to 70 cm/s, but Nyquist is affected by the box size and depth.⁵  To evaluate the opening of the pseudoaneurysm, a larger box size was used to image the area of flow from the aorta to the pseudoaneurysm. Our Nyquist limit was lower than recommended range, but turbulence flow entering the pseudoaneurysm can be expected as a result of the narrow opening of the pseudoaneurysm.⁶ 

The author declares no competing interests.