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We would like to thank González-Calle and colleagues1González-Calle D. Barreiro-Perez M. Sánchez P.L. Better transoral than transnasal transesophageal echocardiography with microprobe (letter).Ann Thorac Surg. 2020; 109: 1308-1309Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar for their comments on our article.2Wang B. Zhang L. Sun W. et al.Transnasal transesophageal echocardiography guidance percutaneous left atrial appendage closure.Ann Thorac Surg. 2019; 108: e161-e164Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Transesophageal echocardiography is the accepted gold standard for imaging left atrial appendage (LAA), and it has become the mainstay of the imaging technology to guide LAA occlusion (LAAO) procedures. However, general anesthesia is required frequently in monitoring LAAO with transesophageal echocardiography. The use of the microprobe may represent an alternative imaging modality to guide LAAO because of its avoidance of general anesthesia. In addition, the microprobe can be performed transnasally or transorally, as referenced by González-Calle and colleagues.1González-Calle D. Barreiro-Perez M. Sánchez P.L. Better transoral than transnasal transesophageal echocardiography with microprobe (letter).Ann Thorac Surg. 2020; 109: 1308-1309Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Notwithstanding, the transoral approach will inevitably irritate the tongue roof when using the microprobe, especially for the prolonged examination time during the LAAO, which will result in patient intolerance and discomfort with local anesthesia. Importantly, the transnasal approach can avoid stimulation of the tongue roof, and it can be well tolerated by patients without general anesthesia. Our center previously reported a successful case of LAAO guided by the transnasal approach with the microprobe.2Wang B. Zhang L. Sun W. et al.Transnasal transesophageal echocardiography guidance percutaneous left atrial appendage closure.Ann Thorac Surg. 2019; 108: e161-e164Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar We then used this technique and acquired broad experience. In our present study, the participants tolerated the microprobe well during the procedure. There was no significant discomfort (eg, local pain, chocking, vomiting reflexes) or severe complications (eg, unintentional extubation, esophageal perforation). Only 2 patients (7%) had mild epistaxis after the procedure, and it stopped spontaneously after a few minutes. The electronic nasopharyngoscopic examination to exclude the nasal diseases (eg, rhinitis, rhinostenosis, deviation of nasal septum, nasal polyp, nasal tumor) preoperatively and the rich operating experience of the sonographer in our study both facilitated the insertion of the microprobe and alleviated the discomfort and complications of the patients. In conclusion, we would like to congratulate the authors for their successfully experience in the transoral approach. We also encourage them to try the transnasal approach and to alleviate patients discomfort and complications with the following methods: making adequate patient selection, learning and acquiring more experience with the transnasal technique, using the topical anesthesia and the vasoconstrictor in the nasal passage, and using a prototype soft plastic nasal conduit as reported elsewhere.3Spencer K.T. Krauss D. Thurn J. et al.Transnasal transesophageal echocardiography.J Am Soc Echocardiogr. 1997; 10: 728-737Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar Better Transoral Than Transnasal Transesophageal Echocardiography With MicroprobeThe Annals of Thoracic SurgeryVol. 109Issue 4PreviewEchocardiography is essential in transcatheter structural procedures, such as left atrial appendage occlusion (LAAO). To date, transesophageal echocardiography (TEE) has been the standard imaging technique used to guide this procedure. However, the use of TEE prevents its performance under conscious sedation, as it is not well tolerated by patients. Full-Text PDF