Abstract

Background:In adults, a secundum form atrial septal defect (ASD) is a popular form of
congenital heart defects.An elevation in cardiopulmonary exercise potential was discovered six to
twelve months after the ASD was closed.BNP (B-type natriuretic peptide) is a prohormone
produced by the myocardium and a rise in ventricular wall tension is the trigger for its release.
Both markers have been shown to be extremely susceptible for myocardial stress in a variety of
cardiovascular disorders in many studies.Aim of work:To identify the predictors of left
ventricular outcome after percutaneous closure of atrial septal defect in adults. Subjects and
methods:This study is a clinical trial (pre-post single interventional study) carried out in the
cardiology department at Zagazig university hospital. The study included 80 cases admitted
during one year. All patients were subjected to complete history taking. General examination for
all body systems and local cardiological examination were done. 12 lead ECG, transesophageal
and transthoracic echocardiography were done. Blood samples were drawn after a fasting period
of 12 hours then we measured BNP in a blood sample before, immediately, after and 3-6 months
after procedure. Trans catheter-closure of ASD, with full haemodynamic study was also
done.Results:there was asignificant decrease in the area of the RA and the RV with increased
LVFP with LV wall thickening, impaired LV diastolic function. And atunivariate and
multivariate analysis the results showed that age, ASD size, RV area, RA area, Peak TRPG,
mitral E/e’, TAPSE appeared to be independent predictors of left ventricular
dysfunction.Conclusion:percutaneous closure of an ASD leads to immediate and sustained
changes in cardiac anatomy and functions involving both sides of the heart. The NT-pro BNP
level begins to increase within 24 hours and continue for 30 days after the procedure in relation
to an increase in LV dimension and volume. increased LVFP with LV wall thickening, impaired
LV diastolic function.LVFP, however, decreased to the normal range by 6 months after closure
in most patients. These findings suggest that after transcatheter closure of an ASD with the
removal of a left-to-right shunt, the LV may be subjected to hemodynamic stress, depending on
volume overload