Tee in retinal occlusion: Author reply

Abstract

We agree with Dr. Lee that the advantage of transesophageal echocardiography (TEE) over transthoracic echocardiography (TTE) is more pronounced regarding aortic pathologic conditions, and this was also emphasized in the article. The disadvantages of TEE versus TTE, aside of cost and technical considerations, are inconvenience and possible rare complications, such as respiratory arrest related to sedation, arrhythmias, aggravation of heart failure, and traumatic injury to the esophagus. This is the reason for our recommendation to first perform TTE, which is a noninvasive easy procedure, and follow with TEE in cases with findings that may suggest cardiac or aortic pathologic conditions. We believe that TEE should be considered in the workup of patients with transient monocular visual loss, following the same guidelines as with the patient with retinal artery occlusion; however, no clinical data are available regarding the yield of such an examination. We also believe that the workup in younger patients should be thorough, and TEE should be strongly recommended, especially because potentially treatable findings, such as unsuspected left to right shunt (patent foramen ovale, atrial septal defect) or abnormal intracardiac mass (LA appendage thrombus, tumor mass, or valvular vegetation), can be identified.