الفهرس 
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Abstract
Recently, the prevalence of mitral regurgitation (MR) has increased in the United States and Europe and the most common causes of MR are degenerative, ischemic, endocarditic, and rheumatic processes.
In acute severe MR, a sudden volume overload is imposed on LA and LV and the hemodynamic overload often cannot be tolerated, and MV surgery must often be performed urgently while In chronic severe MR the increase in LV and LA size allows accommodation of the regurgitant volume at a lower filling pressure, so the patient may be entirely asymptomatic, even during vigorous exercise for many years.
Echocardiography is the golden tool in diagnosis of MR However clinical presentation, examination, ECG and CXR are helpful
Tei index obtained from tissue Doppler echocardiography (TDE-Tei index) has an advantage of measuring the systolic and diastolic components simultaneously and directly on the same cardiac cycle and is defined as the ratio of the sum of (ICT) and (IRT) over the (ET).
This prospective study was designed to assess the left ventricular performance with Tei-index obtained from tissue Doppler echocardiography in patients with severe mitral regurgitation and normal ejection fraction.
This study was carried out in 40 patients with severe mitral regurgitation (more than grade II) diagnosed by echo criteria and the patients were subdivided into two groups:
Gp I (20 asymptomatic patients) & gp II (20 symptomatic patients) both were comparable to gp III (20 patients age-matched healthy controls).
Exclusion Criteria: Subjects will be excluded if they have any of the followings:
7. Patients with concomitant coronary artery disease.
8. Atrial fibrillation.
9. Other moderate or severe valvular diseases.
10. Patients with left ventricular ejection fraction less than 50%.
11. Bundle branch block.
12. Previous cardiac surgery.
All patients included in this study were subjected to thorough history taking, complete physical examination, 12 lead resting electrocardiography, chest X ray and transthoracic echo-Doppler study using the following parameters for measurement (M-mode, Two dimensional echocardiography, colour Doppler, conventional Doppler and tissue Doppler imaging (TDI).
The study included 18 males patients and 22 females patients, aging between 13-58ys (mean±SD 36.23±9.06) and 10 males controls and 10 females controls aging between 24-49ys (mean±SD 31.65±6.64).
The most common cause of MR in gp I was MVP (55 %) and palpitation was most common clinical presentation (50%)while in gp II was RHD (45%) and dyspnea was most common clinical presentation (100%).
There was no significant difference between the three groups in systolic BP but diastolic BP was significantly lower in gp I and gp II than in gp III (P < 0.001 , P=0.001 respectively ) also HR was significantly higher in gp II than in gp I and gp III (P= 0.037 ,P =0.005 respectively).
Regarding 12 lead ECG; P mitral was detected in 10% of gp I and 20% of gp II but as Regarding chest x-ray findings; increase cardiothoracic ratio was the most common finding in gp I (15%)while increase bronchovascular markings was the most common finding in gp II (90%).