We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Angina is characterised by strong, oppressive pain in the chest that spreads to the neck and left arm. It is a sign of lack of oxygen in the heart. It is normally caused by a condition in the coronary arteries, which are the arteries responsible for carrying oxygen to the heart tissue.
Intense pain that appears quickly and intensifies over the course of a few minutes in the chest. It is accompanied by sweating, nausea, vomiting and can spread across the whole chest, the left arm, the neck, and the bottom part of the face.
Angina should be differentiated from the pain that can be caused by pericarditis (inflammation of the membrane surrounding the heart), from hiatal hernia (stomach hernia) and from musculoskeletal pain. It can also be confused with indigestion.
It can affect any age group in adulthood. It is very rare in children. There is a correlation with age (the risk increases as age increases), and there is a slight predominance in males.
Based on clinical observation, electrocardiogram and on determining different blood parameters that show changes in the heart muscle. Diagnosis can be made during an episode of pain, or through a stress test to highlight it, under strict medical control.
The definitive diagnostic test is cardiac catheterisation, which shows blocked areas and often allows the blockage to be cleared with the same catheter.
Electrocardiogram, echocardiogram, nuclear magnetic resonance of the heart, and also cardiac catheterisation which has a diagnostic and therapeutic aim as it can improve blockages in the coronary arteries.
Treatment is aimed at reducing the risk factors, especially tobacco, and improving blood flow in the heart, with the use of various vasodilators.
Health education is essential for those suffering from angina, in order to avoid triggers (quick and intense exercise without warming up) and risk factors (tobacco and alteration of fat content in the blood).
There are numerous coronary vasodilators and various pharmacological families. One thing they all have in common is that they improve coronary blood flow. Controlling arterial hypertension is essential to reduce cardiac effort and overloading of the surrounding vessels.
Cardiac catheterisation consists of inserting a catheter via the arm or leg that reaches the heart and uses contrast to detect coronary obstruction. It thus allows the blockage to be cleared using a dilator or by inserting a stent (an artificial object that allows the flow of blood along the coronary artery to remain open).
Cardiac surgery allows coronary reconstruction with the heart in hand, using artificial arteries or the patient's own vein, which can be taken out of other parts of the body, such as the legs. The advantage is that the reconstruction is better and the disadvantage is that it entails open surgery with the use of extracorporeal circulation.
Tobacco is a big risk factor for developing angina. It should be completed avoided. Controlling fats in the blood and moderate, constant physical exercise are very important.
It is also important to have a healthy diet and regular light or moderate exercise continued over time.
Another important aspect for those who suffer from angina is information relating to how to lead a normal life, over many years, with close monitoring of medication and the relevant tests. Many people have a long life with very few issues after having had angina, as long as the condition is closely controlled.
Cardiology, Cardiac surgery, Haemodynamics and cardiac catheterisation, Intensive care.
Minority diseases, also called rare diseases, are those that affect between 5% and 7% of the population. They are very varied, affecting different parts of the body with a wide range of symptoms that change both between diseases and within the same disease. It is estimated that some 30 million people in the EU, 3 million in Spain, and around 350,000 in Catalonia suffer from one.
The complexity of most rare diseases requires multidisciplinary care with professionals from different medical specialities, case management for nursing, psychological support and also social work.
The Vall d'Hebron Barcelona Hospital Campus is home to more than 100 specialist professionals dedicated to the care of more than 2,000 rare diseases. Apart from treating the most rare diseases of any centre in Spain, it is one of the leading hospitals in Europe in this field. In fact, Vall d'Hebron is part of 20 European reference networks, known as ERN. This makes this hospital a highly specialised centre for rare diseases, from birth to adulthood, through a networked system that allows sharing of resources and knowledge with other world-class hospitals.
Adult and child
Pediatric
This concentration of patients with rare diseases at Vall d'Hebron improves knowledge and promotes research. Research in this field focuses above all on improving diagnostic capacity for diseases that are often difficult to diagnose and on developing new treatments for those diseases. In the case of diseases with few patients, publicly funded research is often the main avenue for the discovery of new drugs, and public health is the framework that provides the public with access to high medication complexity.
For more information, contact the Rare Disease Team at the following email address: minoritaries@vallhebron.cat
Hereditary metabolic diseases (HMDs) are a group of rare genetic disorders. The genetic defect causes a structural alteration in a protein that is involved in one of the metabolic pathways, causing it to block the affected pathway. As a consequence, this causes a build up of substances that may be toxic for the body and a deficiency of others that it needs.
Hereditary metabolic diseases (HMD) are chronic progressive multi-system illnesses that may appear at any age and that in most cases pose diagnostic and therapeutic challenges. Our Unit has been recognised as a leader within Spain (CSUR) and Europe (ERN) for this pathology and takes part in the neonatal screening programme in Catalonia. We are the only centre in Catalonia to offer complete care from paediatrics to adults with particular expertise in lysosomal storage disorders.
HMDs are divided into:
- Intermediary metabolism HMD: usually with acute symptoms.
- HMD related to the organelles (lysosomal storage disorders, peroxisomal diseases, mitochondrial disorders and endoplasmic reticulum storage diseases): chronic presentation with no decompensations (with the exception of some mitochondrial disorders)
Multiple systems in the body are affected and different organs and systems are involved with varying symptoms depending on the disorder and the patient’s age. These disorders require a coordinated approach to care and programmes to manage the transition to adulthood.
Many symptoms become evident during childhood in the form of delayed physical growth and delayed psychomotor development. There may be associated heart problems, kidney conditions, and at times decompensations leading to liver or kidney failure and neurological impairment. In the case of organelle disorders, symptoms are chronic and affect the bones and organs of the senses in greater measure. They are more common in adults than intermediary metabolism disorders.
Diagnosis is carried out by:
They are chronic disorders that need to be treated in specialised centres with multidisciplinary teams to provide support for all related health problems.
The following may be necessary, depending on the type of disorder:
Prevention consists of thorough genetic and reproductive counselling if there is a family history of the disease. Early diagnosis of some diseases through the neonatal screening programme enables effective treatment and improved prognosis.
It is a congenital heart defect characterised by the tricuspid valve sitting lower than normal over the ventricular myocardium, caused by the corresponding atrioventricular ring. In this case, the right atrium greatly increases its volume and the right ventricle greatly reduces in size and lung flow is not sufficient.
Ebstein’s anomaly encompasses a wide range of defects characterised by different grades of displacement and adherence of the septal valve of the tricuspid valve to the right ventricle chamber. It is a very variable disease that may be severe or mild.
The most serious cases are accompanied by severe cyanosis and congestive heart failure.
In less serious cases, the disease results in a transient period of cyanosis.
This is considered a rare disease and only represents 3% of congenital heart defects. It affects one in every 20,000 live births.
An echocardiogram is used to detect the disease, and to find out if it is associated with anatomical or functional atresia of the pulmonary valve.
The defect is treated with surgery which varies depending on the clinic, the anatomical form of the defect and the age of the patient.
In the case of new-born babies, for example, it is necessary to operate as soon possible. In adolescents or adults with symptoms, it is advisable to repair or replace the tricuspid valve with a prosthetic. If patients have no symptoms the best option is to wait.
Following surgery, 80% of patients diagnosed as teenagers or adults have a very good short to mid term prognosis as their ability to function has improved.
Pulmonary stenosis is a disorder of the heart valve that affects the pulmonary valve, the valve which separates the right ventricle from the pulmonary artery, which is the artery that transports blood to the lungs. Pulmonary stenosis occurs when the valve is unable to open sufficiently and as a result there is less blood flow to the lungs.
Mild stenosis produces no symptoms.
If it is more severe, symptoms may be:
An echocardiogram is the usual way to diagnose the condition. This test assesses the right ventricle, the pulmonary valve, post-stenotic dilatation of the pulmonary artery and pressure gradients through the valve.
Percutaneous pulmonary valvuloplasty is used to treat pulmonary stenosis, and is suitable for patients with a moderate condition over two years old.
In severe cases, percutaneous pulmonary valvuloplasty can be carried out at any age. This procedure is associated with a lower short term morbidity and mortality rate than surgical valvotomy. The procedures have similar long term outcomes.
Valvuloplasty generally attains excellent results. At a 15-year check up, only 4 % of cases need a second procedure. Mild pulmonary valvular insufficiency is well tolerated.
Congenital mitral valve anomalies include a wide range of irregularities in the valves and subvalvular systems. This can cause problems from obstruction to mitral valve insufficiency. Two specific problems can occur: stenosis, which affects children; and congenital mitral insufficiency.
Congenital mitral stenosis tends to appear in the first two years of life,
and congenital mitral insufficiency occurs where there is an excess of liquid in the lung which causes breathing difficulties.
Symptoms of congenital mitral stenosis are:
Congenital mitral insufficiency results in an increase in respiratory infections.
Congenital mitral valve anomalies are rare and make up 0.5% of congenital heart defects.
The disease is detected via echocardiogram, which provides information on the valve’s components. This technique also allows any other associated damage present to be seen.
Congenital mitral stenosis requires different kinds of treatment depending on how severe it is.
Children who have undergone surgery can have a normal life but must be monitored by a cardiologist. However, as the child grows they may need a new procedure to adapt the valve to their growth until they reach adulthood.
In the case of congenital mitral insufficiency, surgical repair or replacement of the valve is necessary in patients with symptoms who have severe mitral insufficiency and do not respond to treatment.
A congenital cyanotic heart defect is a congenital heart disorder in which deoxygenated blood bypasses the lungs and enters the circulatory system, or where there is a mixture of oxygenated and deoxygenated blood entering the system. It is caused by structural defects in the heart such as bidirectional shunting, or the incorrect position of the pulmonary artery or the aorta, or any condition that increases pulmonary vascular resistance. The result is the development of collateral circulation.
Children with this heart condition will have the following symptoms:
Tetralogy of Fallot makes up 10% of all congenital heart disorders and is considered the most common cyanotic heart disease. There are around 400 cases for every million births.
Diagnosis is confirmed via 2D echocardiogram.
Repair is carried out around six months old. If the baby suffers a episode before the defect has been corrected, treatment is started in the form of beta blockers to reduce lung spasms.
If very severe cyanotic episodes persist in babies under six months despite this treatment, then palliative surgery needs to be performed to take blood to the lungs. This surgery consists of making a connection between a systemic artery and the pulmonary arteries (a systemic-pulmonary fistula).
The definitive corrective surgery involves closing the ventricular septal defect with a patch and widening the outlet from the right ventricle.
In cases of severe pulmonary insufficiency there is progressive dilatation of the right ventricle in the long term. If this becomes excessive, it is necessary to replace the valve. Risk of lung valve replacement is around 20% after 25 years.
Unfortunately, there are currently no measures that can be taken to prevent this heart condition.
Pulmonary arterial hypertension (PAH) is a disorder of the arteries that connect the lungs to the heart. Symptoms are shortness of breath or laboured breathing (dyspnoea).
Pulmonary arterial hypertension is a rare and serious condition that affects the pulmonary artery system. As the disease progresses, blood flow reduces. To compensate for this, the right side of the heart grows excessively, creating breathing difficulties.
It is defined by a rise in pulmonary artery pressure caused by abnormalities in the precapillary pulmonary arterioles due to uncontrolled hypertrophy, hyperplasia and proliferation.
Dyspnoea, syncope, palpitations.
It affects children and adults, especially women (65-80%) and usually appears in adulthood.
In around 50% of cases of pulmonary arterial hypertension the cause is unknown. The other 50% are related to:
In Spain there are 16 cases for every million adults and the incidence rate is 3.7 for every million adults per year.
Diagnosis is via a series of tests:
Although they will not cure it, there are several treatments that can significantly improve the condition, its prognosis and patients’ quality of life.
We are fortunate to have access to all the pharmaceuticals beneficial in fighting this disease:
The decision about the most suitable drugs for each patient needs to be made by centres with experience. Lastly, if these measures are insufficient, a lung transplant can be considered in some cases.
Taking anorectics, amphetamines and cocaine should be avoided. The HIV virus can also cause this condition and all factors, principally alcohol, that may lead to liver failure. Apart from these measures there are no other means of prevention and efforts should focus on early detection.
Anticoagulants are the treatment of choice for venous thromboembolic disease. They are also used in patients with a heart arrhythmia or heart condition that predisposes them to having a systemic embolism (formation of a clot or thrombus that travels from the heart to any blood vessel in the body) or from the heart to the veins in the brain causing a stroke.
Anticoagulants are medication that modify blood clotting so that a thrombus or clot does not form inside the blood vessels. The main effect is to slow the blood’s clotting time.
There are different types of anticoagulants: injectable or oral.
Low molecular weight or unfractionated heparin. Should be started at therapeutic doses as soon as thrombosis is suspected, even before the diagnosis is confirmed, or as prophylaxis (prevention), at prophylactic doses, when the person has one or more risk factors that could trigger a venous thromboembolism (such as hip or knee replacement surgery). They are administered at fixed doses according to the patient’s weight, the type of thrombosis being treated or risk factor being controlled.
They are used as maintenance therapy when oral anticoagulants are contraindicated (e.g. pregnancy) or have been ineffective.
They are used as maintenance treatment (longer use) and are given on confirmation of the diagnosis of deep vein thrombosis or pulmonary embolism. There are two types of oral anticoagulants: vitamin K antagonists and direct-acting.
The anticoagulant treatment is controlled with blood tests or capillary blood tests (by pricking the patient's finger). Monitoring of patients on anticoagulant treatment is done by haematology and haemotherapy specialists.
This small device, which is implanted beneath the collarbone thanks to a small incision, sends electrical impulses to the heart so that it can beat at a constant pace.
Pacemakers help regulate the rhythm of the heart when natural stimulation fails, meaning they are used when the heart rate is slower or faster than it should be, with irregular beats, or if there is a blockage in the electrical system of the heart. Normally there are two causes:
There are two types of pacemaker:
The artificial pacemaker consists of an electric impulse generator, the pacemaker, and a conductive cable. To install it, an incision is made in the chest, below the left collarbone.
The cable is inserted into the right atrium or the right ventricle, depending on the disease. If the patient only needs one electrode, it is placed in the right ventricle. If he or she needs two, the other is placed in the right atrium.
We check it is placed properly by means of a radiological procedure and, if everything is correct, it is connected and remains under the skin. Afterwards the incision is sutured.
Once implanted, the electrodes transmit signals to the heart that the device detects as signals, and sends the electrical impulses to the heart to stimulate it rhythmically.
Always carry your European pacemaker patient card with you, as it contains all the information about the type of pacemaker and its settings.
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