Fellow Research Spotlight
Rachel (Bounds) Hansen, M.D., Third Year Pediatric Cardiology Fellow “Pulmonary valve stenosis after percutaneous balloon valvuloplasty: Long-term follow-up”
By Meghan Plog, MS
Rachel (Bounds) Hansen, MD, third year pediatric cardiology fellow, is in the final stages of her research focusing on pulmonary valve stenosis (PVS), an extremely common congenital heart defect (present in 8-10% of children with congenital heart disease). She specifically analyzed risk factors and long-term outcomes after balloon pulmonary valvuloplasty (BPV), a catheterization procedure that has only been in existence since 1982. Prior to then, the only treatment for PVS was surgery. BPV has provided a minimally invasive way to treat this common congenital heart defect, but given the procedure’s relatively short history, very little information exists on long-term outcomes. Dr. Hansen partnered with the cardiology groups in neighboring Buffalo and Syracuse to gather and analyze data from all three centers, creating the largest cohort, multicenter study of its kind to date.
The study included 254 patients, spanning from the early 1980’s to 2015. Looking at both short and long-term follow-up, she aimed to evaluate the incidence and risk factors for residual PVS, repeat intervention, and moderate to severe pulmonary insufficiency (PI) for up to 25 years following BPV. The findings have important clinical implications, as they were ultimately able to prove that initial BPV is successful in relieving PVS. 83% of patients had a good result from initial BPV, and only 16.6% of the patients with greater than ten years of follow-up required repeat intervention. Risk factors for residual PVS or the need for repeat intervention were identified and included younger age, lower weight, more severe initial PVS, and the presence of a genetic syndrome. Knowing these risk factors can give providers a better indication of which patients are likely to need repeat intervention, ultimately allowing them to better prepare families.
Secondarily, she studied the rate of pulmonary regurgitation following BPV. Interestingly, patients who underwent BPV in the earlier decades, prior to January 2000, had significantly more regurgitation than those whose procedure took place post January 2000. While there hasn’t been a difference in technique or patient population, this suggests an increase inherent to the disease that occurs over time, which is a finding that has the potential to change the way patients receive follow-up. Whereas it was originally thought that a good result from BPV and follow-up through childhood was sufficient, this suggests that much longer follow-up should occur throughout a patient’s life to treat changes that could develop over time. Furthermore, multiple modes of imaging, including MRI, may be useful to better assess severity of PI. These conclusions have the potential to inspire change in current practices nationally.
Dr. Hansen presented this data at the Society for Cardiovascular Angiography Interventions (SCAI) meeting in May 2017, as well as co-authored an abstract at the 2017 Pediatric Academic Societies (PAS) meeting. Following fellowship, she plans to pursue a pediatric cardiac ICU fellowship at Lurie Children’s Hospital in Chicago, IL.