Torsional deformation versus fractional ejection with acute (top) and chronic (bottom) mitral regurgitation in a representative animal. With acute mitral.

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Torsional deformation versus fractional ejection with acute (top) and chronic (bottom) mitral regurgitation in a representative animal. With acute mitral regurgitation, systole (solid line) is characterized by a slight clockwise rotation followed by counterclockwise torsion that peaks at end-ejection. Early diastole (dashed line) shows steeper torsional recoil than middle to late diastole (dotted line). With chronic mitral regurgitation, the initial clockwise torsion is larger, the maximum positive torsion is decreased, and less recoil occurs during early diastole. (Reproduced with permission from Tibayan FA, Yun KL, Fann JI, et al: Torsional dynamics in the evolution from acute to chronic mitral regurgitation. J Heart Valve Dis 2002; 11:39.) Source: Chapter 40. Pathophysiology of Mitral Valve Disease, Cardiac Surgery in the Adult, 4e Citation: Cohn LH. Cardiac Surgery in the Adult, 4e; 2012 Available at: http://accesssurgery.mhmedical.com/DownloadImage.aspx?image=/data/books/cohn4/cohn4_c040f013.png&sec=39686157&BookID=476&ChapterSecID=39679055&imagename= Accessed: October 21, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved