الفهرس 
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Abstract
Left ventricular (LV) twist and untwist are fundamental components of myocardial contraction which describe the rotation of apex and base around the LV long-axis in opposite directions throughout the cardiac cycle. Since ventricular muscle bands are oriented spatially as a helix, systolic ventricular contraction involves longitudinal shortening with concomitant ventricular twisting—akin to a “wringing motion,” which enhances ventricular ejection. LV twist increases efficiency of systolic contraction, while untwist increases diastolic suction and facilitates early diastolic filling. Assessment of LV twist dynamics provides a unique measure of LV systolic and diastolic function which may add incremental value to current techniques and provide novel insights into ventricular performance in the dynamic surgical setting.
Assessment of LV twist mechanics, however, are not attainable with conventional echocardiographic assessment and have proven difficult to measure. Use of speckle-tracking imaging (STI), however, provides a more versatile technique to assess LV rotational mechanics in the clinical and research settings compared with other imaging modalities
Aim of the work
Assessment of left ventricular mechanics in patients with severe mitral valve regurgitation pre and post mitral valve replacement.
Patients and Methods
This study was done on thirty patients presented with severe degenerative mitral valve regurgitation in Menoufia University Hospital from January 2020 to March 2021, they were enrolled in the study after written informed consent and approved by ethics committee of Menoufia university.
All study participants underwent full history taking, general examination, local cardiac examination, 12- lead electrocardiogram, Conventional echocardiography, and 2D-STE (including assessment of longitudinal strains, different systolic and diastolic twist parameters (apical and basal rotation, peak twist, time to peak twist, peak untwist rate, time to peak twist rate, time to peak untwist rate
Results:
Our study showed significant decrease in LV dimensions and volumes post operative in comparison to preoperative study.
Our study showed significant improvement in RVSP, grade of TR.
Our study showed RV basal dimensions decreased significantly at early post operative then showed no significant change at 3 month follow up.
There was improvement of exercise tolerance presented by NYHA classification post operative.
Our study showed significant decrease of GLS in early post operative study in comparison to preoperative study which significantly recovered at three month follow up study.
Our study showed significant decrease of peak twist in early post operative study in comparison to preoperative study which significantly recovered at three month follow up study.
On comparing untwist rate pre, early and late post operative we found that, there was a significant difference as regard untwist rate between pre vs late post operative. There were a significant difference as regard untwist rate between early and late post operative. There was no significant difference as regard untwist rate and time to peak untwist between pre vs early post operative.