In Reply: Dr Mirakaj and colleagues highlight the effect of atheromatous disease of the aorta on perioperative stroke. We agree that epiaortic echocardiography is a more sensitive manner to detect atheroma, but the results of these studies have not been systematically collected at our institution. However, qualitative aortic arch atheroma data from transesophageal echocardiography were available in nearly all of our patients and were included in our analysis. The high prevalence of atheroma seen in this population makes it unlikely that many such plaques were missed using this technique.
Hart SA, Krasuski RA, Blackstone E. Intraoperative Diagnosis and Management of Patent Foramen Ovale—Reply. JAMA. 2009;302(21):2317-2318. doi:10.1001/jama.2009.1745