This report provides a morphological description of atypical and unusual mitral and submitral calcifications in patients with end-stage renal disease. The use of transesophageal echocardiography (TEE) with enhanced image quality and resolution has made possible a detailed evaluation of the distribution and echocardiographic morphology of mitral calcification in end-stage renal disease. To our knowledge, there has been no such prior report with TEE. Our TEE observations reveal that in addition to the common well known posterior mitral annulus calcification, the following varieties of calcification also exist: basal calcification of both mitral leaflets with sparing of free edges, calcification in the intervalvular fibrosa region, and small calcific excrescences at the bases of both mitral leaflets. These abnormalities have previously received little or no attention.