الفهرس 
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Abstract
Mitral valve disease is one of the most common morbidity and mortality in developed countries. Symptoms of mitral valve disease can be asymptomatic or manifest heart failure symptoms including orthopnea, dyspnea, and PND. Assessment of severity of mitral valve disease and LV remodeling is important as it impact on management strategy.There are two strategy for treatment: conventional medical therapy and valve surgery either repair or replacement. Conventional medical therapy cannot prevent disease from progression or prevent LV remodeling, so mitral valve surgery is the ideal management but accurate time for surgery is a difficult decision. Speckle tracking is a new ECHO modality tools used in assessment of subclinical LV dysfunction and early site of LV remodeling that may change the strategy of management of valvular heart disease in the future. Longitudinal strain give idea about segmental affection of mitral regurgitation on LV function.Our study done on 30 patients of primary mitral regurgitation and role of longitudinal strain in those patients and it’s role in rheumatic and myxematous mitral regurgitation.
In rheumatic mitral regurgitation shows mainly basal affection of LV, while in myxomatous MR it affect some basal and mid segments. In asymptomatic MR, it shows normal or super normal segmental longitudinal strain of LV with normal EF, that may be explained by pathophysiology of mitral regurgitation. In symptomatic MR, it shows early affection at basal segments followed by mid segments but apical segments remain normal or increased in longitudinal strain to compensate the decrease in other basal segments. Early detection of LV remodeling in patients with severe primary mitral regurgitation can change the guidelines regarding the treatment of this disease. Speckle tracking can be used as a tool for assessment of LV function in mitral regurgitation and may be used instead of conventional method (EF) as a guide in treatment of mitral regurgitation. Till now no guidelines for normal values of longitudinal strain that can be used as marker for indication of surgery in chronic primary mitral regurgitation as it need more studies due to different software’s.