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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).

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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.
A patient had the following echo loops.
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.
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