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On the June 2019 issue of the Archives of the Turkish Society, Kılıçaslan et al.[1] reported the relationship between cardiac adaptations and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels after percu taneous closure of atrial septal defects (ASD). ASD is one of the most frequent (5%–10%) congenital heart diseases in adults.[2] Patients with an ASD have a left-to-right shunt and the consequent chronic volume load of the right atrium, right ventricle, and pulmonary artery can cause heart failure and pulmonary hypertension.[3] Reduction of right atrial and right ventricular diameter after ASD closure is an expected finding, and in previous studies, it has been demonstrated that closure of an ASD may lead to reduced right heart volumes due to diminished left-to-right shunting.[4] Brochu et al.[5] reported that even asymptomatic adult ASD patients experienced a significant increase in their functional capacity after percutaneous closure. NT-proBNP is secreted in response to atrial and/or ventricular stretch and shows a significant positive relationship with the amount of the left-to-right shunt.[6–8] It doesn’t increase only in heart failure or systolic dysfunction, but also in diastolic dysfunction and right ventricular dysfunction. [7] Pre vious studies on the natriuretic peptic levels after shunt closure demonstrated significant decreases in plasma BNP levels concomitant with significant improve ments in functional capacity, decrease in pulmonary artery systolic pressures and in crease in tricuspid annular plane systolic excursion (TAPSE) values one month after the procedure. Increase in TAPSE measurements and decrease in NT-proBNP may be useful for monitoring the success of the intervention.[8–11] In the Kılıçaslan et al.[1] study, although the right ventricle and right atrial end diastole diameters and volumes decreased, the BNP level and right ventricle myocardial performance indices increased significantly. This is consistent with the physiological alterations of the right ventricle and is explained by the lower volume in the ventricle after closure. Of particular interest in the present study was the increase in BNP concentrations after ASD closure.

Association of cardiac adaptations with NT-proBNP levels after percutaneous closure of atrial septal defect