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With this next case, we're gonna review a patient who has a lot of annular,

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calcifications and L V O T calcifications of the type that you would certainly

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wanna mention as severe calcifications in your report.

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These are the types of calcifications that put the patients at higher risk for

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annual rupture during the procedure need for pacemaker after the procedure,

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and a higher risk for paravalvular regurgitation because of these large

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calcifications. So on the axial images, what we're gonna see, uh,

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below the level of the coronaries and at the level that UIC valve,

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you can see actually there's quite a lot of calcification of this leaflet here.

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That's probably the left cusp. And then it extends below

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into the annulus and then you can see it also extends all the way over here into

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the mitral and in the region. And then even along this, um,

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anterior leaflet of the mitral valve.

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So I wanna show you that on the N P R images.

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So these are just standard double oblique images.

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You don't need to pay attention to the left upper hand corner image.

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We're just gonna focus on these axial coronal and sagal images and the other

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three windows.

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So if we adjust our planes to get a good look at the aortic valve by centering

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on the aortic valve plane, on the coronal image,

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rotating counterclockwise with our, um, axial plane,

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and then doing the same with the other long axis image here so that we're

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parallel to the aortic valve, then you get a nice look,

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nice short access look of the aortic valve. In this patient.

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You can see the tricuspid valve.

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There's three separate leaflets with a good bit of calcification.

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And this patient, you see this calcification extending inferiorly along the

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annulus and down into the, uh, mitral valve.

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So this is called the aorta mitral continuity or AOR mitral curtain.

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There are different names for it,

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but basically it's just a fibrous connection between the aortic valve and the

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mitral valve. And so when you see a lot of calcification here,

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you wanna mention it, it is considered, um, you know,

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more high risk calcification. Now,

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other spots where you see calcification not in this patient that are important

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to mention would be if you have a large nodular calcifications

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or protruding against the lumen. You can see this is flat,

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but if you had a big nodule sticking outta the lumen,

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you definitely wanna mention that because that can interfere with apposition of

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the stent structs and you can get paravalvular leak.

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And then the other thing is if you have a lot of calcification below the level,

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the non coronary cusp, which is this one right here,

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that points posteriorly towards the inter atrial septum,

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you wanna mention that too because those are also considered higher risk for

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some of these complications that we discussed.