Evaluation of left atrium and right ventricle function by echocardiography after percutaneous ASD closure and its relationship with BNP levels

Introduction and Objective: Atrial septal defect (ASD) is one of the most common congenital heart diseases in adults, with approximately 80% of cases being of the secundum type. In this defect, the shunt mechanism developing from left to right causes volume overload in the right heart and may adversely affect right heart function over time. Today, percutaneous closure of ASD has become one of the standard treatment methods due to its effectiveness and reliability. Monitoring changes in right heart function following percutaneous closure is important for both clinical follow-up of patients and prognosis assessment. However, the complex geometric structure and physiological differences of the right ventricle make it difficult to evaluate using conventional echocardiographic methods. Advanced imaging methods such as strain and strain rate measurements offer the possibility of more accurately evaluating the global and segmental functions of the right ventricle. In this study, changes in left atrial and right ventricular strain and strain rate parameters were examined in patients with ASD following percutaneous closure. At the same time, the relationship between these changes and plasma BNP levels was investigated. Methods: This prospective study included 24 patients who underwent percutaneous ASD closure at the Department of Cardiology, Yüzüncü Yıl University, in 2024, and 24 healthy individuals with similar characteristics in terms of age, gender, and body mass index. The patients' detailed medical histories were obtained, physical examinations were performed, and transthoracic echocardiography, BNP measurements, haemogram, and routine biochemical tests were conducted prior to the procedure. In patients with ASD, echocardiographic evaluation and BNP measurements were repeated on the first day and first month after the procedure, and the obtained data were compared with the control group. Results: In the study, which included a total of 48 participants, the demographic characteristics of ASD patients were similar to those of the control group. All ASD patients were in sinus rhythm and had no serious comorbidities. A significant reduction in right atrial diameter was observed at one month after the procedure, but no significant change in right ventricular diameter was detected. According to strain analysis, the right atrial and right ventricular strain values of patients with ASD were lower than those of the control group. Left atrial strain values increased in the first month after the procedure compared to baseline values. However, no significant change was observed in right ventricular strain values. BNP levels did not show a significant difference between the first day and the first month after the procedure. Conclusion: Percutaneous ASD closure is an effective and safe treatment method that positively affects cardiac function. The increase in left atrial strain parameters reflects the early cardiac improvement effects of the procedure. However, the lack of a significant change in right ventricular strain values in the early period suggests that this parameter may be more appropriate for evaluation in long-term follow-ups. The absence of changes in BNP levels in the early post-procedure period indicates that haemodynamic stability is maintained. These findings contribute to the current body of knowledge in the field while also highlighting the need for more comprehensive and long-term studies in the future.