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.
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.
ECMO is a technique used in critical patients suffering from extremely serious respiratory and/or cardiovascular diseases where conventional life support is insufficient. The machine temporarily replaces lung or heart function, enabling the organs to rest while the underlying illness is treated.
The machine removes blood through a thick tube inserted into a major vein and transfers it to a centrifugal pump. The pump pushes it through an oxygenator, where oxygen is added and carbon dioxide removed. Subsequently, it is reintroduced into the patient’s body. If this is done through another vein, it is known as veno-venous (VV) ECMO and provides respiratory support. Where it is done via an artery, this is known as veno-arterial (VA) ECMO and provides support for both the heart and lungs.
ECMO is not a treatment per se but rather a support mechanism. It optimises organ recovery but does not resolve the underlying problem. In fact, one of the reasons to use the procedure is its reversibility for patients. The system is highly effective in replacing vital organ function. However, it is currently a last option for a specific patient group given its complex nature and associated risks, such as bleeding, thrombosis and infection.
Regardless of the support strategy chosen, this is a highly complex technique associated with a high risk of serious complications. That is why, in order to ensure excellent care, a well-organised programme is required, with optimal material and sufficient numbers of properly trained staff. Cases need to be clustered at leading centres and units with the necessary resources and material to ensure effectiveness, as well as a highly trained multidisciplinary team.
The Extracorporeal Life Support Organization (ELSO) is the benchmark international scientific association for ECMO. It establishes care and organisational guidelines, coordinates teaching activities and promotes research in the field. The organisation has a multi-centre database with information on over 200,000 patients. Although patients receive optimal care through ECMO with excellent survival rates, they often have later side effects due to the seriousness of their illness and the intense nature of their care, both during ECMO and with prior treatment.
Vall d’Hebron is home to two ECMO programmes. One is for adult patients and led by Dr Jordi Riera, and the other is for children and new-born patients, led by Dr Joan Balcells.
Our programmes follow ELSO guidelines at all levels, from lifelong, multidisciplinary and skill-based training for ECMO teams to filling in records for continuous assessment, as well as optimised protocols that align with our context and setting.
Our programmes take a long-term outlook, focused on getting patients back to their daily lives with maximum functional recovery. In this sense, we prioritise minimal deep sedation and safe early physical rehabilitation, even where recovery of the failed organ is still ongoing. ECMO support makes this possible by substituting heart and lung functions. Moreover, patients are able to directly interact with professionals and family members.
Veno-Arterial (VA) and Veno-Venous (VV):
The VA option provides heart and lung support by taking over organ functions. It is used when there is a cardiorespiratory problem, such as a heart attack or myocarditis (inflammation). The VV option is used to provide respiratory support and takes over lung function. It is used where there is a breathing issue, such as pneumonia or an acute blockage in the airways.
Peripheral or central line:
Patients are normally connected to an ECMO machine through cannulae (thick tubes) in the neck or groin. This is known as a peripheral line. At times, the machine needs to be directly connected to a patient’s heart or very close to the heart through the chest. This is known as a central line.
Special scenarios:
ECMO is an effective system but can pose major risks for patients. In terms of frequency and potential seriousness, these risks include bleeding and infection.
Bleeding is due to the fact that patients are often treated with blood thinners. Infection is due to receiving highly invasive therapy and the severity of the illness.
In order to minimise these risks, it is essential to have a properly trained multidisciplinary ECMO team, cluster ECMO cases and resources, and ensure robust records comparable to other consolidated external records.
The Cardiovascular Critical Care Unit is a part of the Cardiology Department at Vall d’Hebron. It treats people with acute and serious cardiovascular disease. It mainly looks after cases of complex ischaemic heart disease, such as acute myocardial infarctions or chest angina.
The Cardiovascular Critical Care Unit (initially known as the Coronary Care Unit) was created in 1971 to admit patients with acute myocardial infarction, or other acute cardiovascular diseases. It also dealt with cardiac surgery post-operative care. In 1989 the unit was divided into two. The current Cardiovascular Critical Care Unit became responsible for the patients and became a part of the Cardiology Department.
Aortic diseases are relatively common, affecting 5% of the population over the age of 65. Abdominal affectation is much more common in the elderly, while affectation of the thoracic aorta is more likely to occur among younger people.
The main problem is that due to the lack of symptoms it can go unnoticed and is often diagnosed through a study using imaging techniques such as echocardiography or CT. The aorta is almost always prone to dilation and aneurysm before rupture, which is why it is very important to diagnose the problem early and to try to slow it down.
Classically this condition has been treated by surgeons. In recent years it has been proven that the only way to improve diagnosis and treatment is to treat the subject in a multidisciplinary manner. Certainly, when the aorta is broken it is vital to offer prompt, careful surgical treatment, but the medical goal is to try not to break it, or to indicate the surgery before the risk is too high. There are two reasons behind aortic disease developing.
The Echocardiography and Cardiac Imaging Unit in the Cardiology Department is responsible for doing the tests needed to diagnose the various heart diseases. These tests are done on heart patients, patients in other specialities and people in hospital. The unit also provides the service for primary care. It is a transversal unit and works with other services at the hospital, such as Radiology. Over the past few years, with this joint work, the Echocardiography and Cardiac Imaging Unit has developed and consolidated several specialist sub-units. Some of them are benchmarks at the Spanish and European level.
The Echocardiography and Cardiac Imaging Unit looks after and manages the needs of a great number of people. It has the most advanced technology and heads up knowledge about the speciality. It is a multi-disciplinary unit and brings together caring for people, research and training in day-to-day activities. It has extensive experience in achieving clinical and research breakthroughs. The unit has achieved and published many research milestones.
The unit's services portfolio includes the following:
The Integrated Adolescent and Adult Congenital Heart Disease Unit (UCCAA) at Vall d'Hebron - Sant Pau is a part of the Cardiology Department, and its mission is to provide multidisciplinary care for adolescent and adult patients living with a congenital heart disease, as well as teaching and carrying out research in this field.
The Adolescent and Adult Congenital Heart Disease Unit (UCCAA) was set up at Vall d'Hebron University Hospital more than 40 years ago, and we have been providing paediatric care for congenital heart diseases ever since. This Unit is the result of a collaboration agreement between our Hospital and the University Hospital of Santa Creu i Sant Pau, to bring together the effort, resources and experience of these two leading hospitals in the treatment of this disease.
The Heart Failure Unit was created in 2009, based on the collaboration between the Cardiology and Internal Medicine Departments. It is made up of cardiologists, internists, specialists in geriatrics and emergency services. Heart failure is the fastest growing heart disease in our society.
Heart failure is the leading cause of major hospitalisation. The ageing population and improvements in medical procedures are both factors that mean several forms of heart disease (valvular, coronary and hypertensive) end up going beyond acute phases and result in heart failure.
Though the mortality of patients during hospitalisation is not very high (4.7%), it is worrying that, once they have been discharged, the rate of readmissions and morbidity and mortality are high (50% mortality 18 months after discharge).
The Cardiology Department Haemodynamics Unit diagnoses and treats diseases of the coronary artery, other parts of the heart, such as valves, and congenital defects. The majority of these procedures are carried out by inserting a catheter into the radial artery in the arm. In a few cases, it is inserted into the arteries in the leg.These procedures are used to treat acute myocardial infarctions and chronic coronary artery obstructions. They also enable intervention within the heart to change malfunctioning heart valves or repair heart defects. These procedures are also carried out on children and adults with congenital diseases.
The Vall d’Hebron Haemodynamics Unit is a centre of excellence with extensive experience in coronary procedures. It has three theatres for operations, one of which is shared with the Arrhythmia Unit. Another one is used for hybrid procedures, with simultaneous participation of specialists in haemodynamics and experts in cardiac surgery.
The unit has the technology and materials needed to carry out any kind of procedure, such as:
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