Echo-of-the-Day

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AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.

Echo-of-the-Day Information

The Echo-of-the-Day is a presentation of 1 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= MP4 Video	= Ogg Video
= WebM Video	= GIF Image
Image/Video Sizes	= JPG Image
1X = 200x150 pixels 2X = 400x300 pixels	3X = 600x450 pixels 4X = 800x600 pixels

Loop Text Key
Preop	Preop TEE or TTE
Intraop	An Intraop TEE
IntraopPreOp	Intraop TEE or TTE before Operation
IntraopPostOp	Intraop TEE or TTE after Operation
IntraopEnd	Intraop TEE or TTE at End of Anesthesia
Post Op	Postop TEE or TTE

Echo of the Day Information Table

IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE

Mitral Valve Lights Up

Case#: 107

AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.

Presentation:
A patient had the following echo loops.

Loop(s):

Case Discussion

The leaflets are thin where the leaflets have not been invaded with calcium. The calcium deposition occurs in the left atrial wall, mitral annulus, and the posterior mitral valve leaflet. The anterior leaflet appears to be spared.

MAC or mitral annular calcification, is a disease of calcium deposition in the mitral annulus that leads to mitral regurgitation more often than mitral stenosis. If a valve can't open normally, it typically can't close normally either. MAC was followed in one study and found that if MAC tended to become more severe with rapid progression the younger the patient at the time of diagnosis. Mitral stenosis with progression of a gradient occurred in 50% of these patients.

If the MV and AV are calcified, then the coronary arteries had a high calcium score as well. AV calcification or AV/MV calcification tended to be associated with isolated LAD disease whereas RCA disease tended to be associated with MAC or AV/MV calcification - however, there was a signifiicant amount of crossover.

MAC can also be associated with intramural hematomas, endocarditis, necrosis, and thrombus formation.

The matrix-GIa protient, a vitamin K dependent protien, is a potent inhibitor of tissue calcification. Coumadin use has been associated with an increase risk of MV or AV calcification.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

Mitral annular calcium causing mitral stenosis.
Association between mitral and aortic valve calcification and preferential left or right coronary artery disease.
Left atrial intramural haematoma associated with mitral annular calcification.
Mobile ventricular thrombus arising from the mitral annulus in patients with dense mitral annular calcification.
Infective endocarditis on mitral annular calcification: a case report.
Liquefaction necrosis of calcified mitral annulus.
Warfarin use and the risk of valvular calcification.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.