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.
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The goal of the Paediatric Cardiology Department is to provide care, teaching and research in the field of heart disease, be it congenital or acquired, from before birth up to adulthood. With more than 40 years’ experience offering patient care, this Department created the Adolescent and Adult Congenital Heart Disease Unit (UCCAA) to provide continuity in care for patients with congenital heart disease
The Paediatric Cardiology Department deals with diseases that affect the heart from the foetal period. Foetal cardiology is developed in collaboration with the Obstetrics, Gynaecology and Neonatology Departments, which have all the human and technical resources necessary to guarantee quality care for treatment of heart disease, congenital or otherwise, detected during the foetal period.
The Cardiology Department Arrhythmia Unit treats heart rhythm disorders. It is responsible for diagnosis, treatment, research and training for all illnesses related to arrhythmias. These may be slow or fast. Slow arrhythmias often need a pacemaker to be fitted. Fast arrhythmias may cause the patient to lose consciousness, or even cardiac arrest.
The Arrhythmia Unit works closely with the Critical Cardiology Unit, the Adult Congenital Heart Disease Unit, and the Inpatient and Cardiac Surgery Areas. The Arrhythmia Unit was created in 1975. Since then it has expanded and specialises in various fields.The most important are as follows:
Resident doctors in Cardiology are offered the chance to work in a centre with highly specialised care activities thanks to the operational structure and cross-cutting programmes that include cardiac surgery and paediatric surgery. Specialists working here deal with a diverse range of disorders such as arrhythmia, congenital heart disease, heart failure, acute coronary syndrome and valvulopathy, among others.
Cardiology training itinerary
The Cardiology Department Teaching Unit at Vall d’Hebron Hospital is divided into nine operational units. These include Outpatients, conventional wards, the Day Hospital, the Coronary Care Unit, Intensive Coronary Care, Semi-critical Care, Echocardiography and Cardiac Imaging, Haemodynamics and Angiocardiography, Arrhythmia, Nuclear Cardiology and the Experimental Laboratory. It should be said that the Cardiovascular Epidemiology Unit, part of the Cardiology Department, is unique within Spain.
We work in multidiscipline areas to treat specific medical problems such as Marfan syndrome and Congenital Heart Disease, and are national leaders in both fields. Our activity is always patient-centred and aims to maximise outpatient care and general cardiology. To this end we regularly run clinical care and scientific sessions that involve all professionals in the Department.
During training, residents progressively increase their level of skill, from taking medical histories at the start of their training, for example, to the use of automatic defibrillators in the final phase of their residency.
During the first year residents undertake shifts in Internal Medicine, with one shift a month in Cardiology. In the second and third year they do shifts in clinical cardiology within the Accident and Emergency Department. The fourth and fifth year include shifts in the Coronary Care Unit and Haemodynamics.
In terms of training, there are sessions, seminars and courses, and residents’ participation in national and international congresses, conferences, seminars and courses is encouraged.
At the end of the cardiology residency, it is possible to continue training in research as part of the Riu Ortega programme for the Carlos III Health Institute. We also take part in undergraduate and postgraduate research staff training programmes run by the Generalitat of Catalonia’s Department for Education and Universities and the Ministry of Education.
Research activities of note include collaboration with the International Doctorate School on myocardial consequences, in cooperation with the University of Giessen (PROMISE), funded by the German organisation DFG and BIOCAT.
Why should you specialise at Vall d’Hebron?
This disease consists of a hole in the partition that separates the right and left chambers of the heart, and a malformation of the mitral valve.
Patients with an atrioventricular septal defect have a hole in the wall between the left and right sides of the heart and a malformation of the mitral valve, which is the valve that regulates blood flow from the left side of the heart.
In the case of a partial atrioventricular septal defect, the upper part (atrial) or lower part (ventricular) part of the partition may be affected. In the case of a complete atrioventricular septal defect, the hole affects both the atrial and the ventricular chambers of the partition.
This heart condition may or may not present symptoms, depending on the size of the interatrial hole and the insufficiency of the mitral valve.
Where there are symptoms, the most common are those related to heart failure:
This is carried out through an echocardiogram to identify the presence of a defect and the degree of mitral insufficiency.
This heart disorder is corrected through surgery, during which a patch is used to close the atrial septal defect and the mitral valve is repaired by closing the hole. The ideal age to repair a partial AV defect is from 1 to 4 years old.
The vast majority of patients with a repaired defect of this type have a similar life expectancy and quality of life to the general population. If it is not corrected, patients may develop pulmonary hypertension, a disease with drastically reduced survival rates from around thirty or forty years old.
Complete atrioventricular septal defect is a congenital heart condition caused by a hole in the wall separating the left and right chambers of the heart.
This is a congenital heart defect caused by a hole in the wall separating the left and right chambers of the heart. This communication affects both the atria (the upper chambers) and the ventricles (lower chambers).
The cause of the defect is the formation of endocardial cushions, which are responsible for the creation and joining of the atrioventricular valves with the cardiac septum, the wall that separates the two chambers.
This heart defect is also characterised by having just one atrioventricular valve in place of two; the tricuspid and mitral valves.
Children with this heart defect show classic symptoms of heart insufficiency or failure. This includes frequent respiratory infections, difficulty feeding and gaining weight.
This makes up 4 % of all heart disease and around half of the heart defects that affect children with Down's syndrome.
Diagnosis is via 2D echocardiogram.
New-born babies tend to undergo surgery for this heart defect when they are six months old. The procedure consist of closing the interventricular or interatrial hole using a patch. The atrioventricular valve is also reconstructed to create a valve on the right side and another on the left.
In children under six months with severe symptoms, a prior palliative procedure called pulmonary cerclage is carried out. This procedure is carried out by narrowing the pulmonary artery using a band to decrease excessive pulmonary flow.
Chagas disease is an infection caused by the “Trypanosoma cruzi” parasite which is transmitted through the bites of an insect (the “kissing bug”).
The disease can also be spread from mother to child (vertical transmission), through blood transfusion, organ donation from people infected with the disease or from eating food contaminated with the parasite.
For the moment, the number of new cases has been reduced thanks to policies to eliminate the insect in countries where it is endemic, as well as thanks to screening programmes aimed at blood and organ donors and pregnant women. The future challenges to cure this disease are maintaining and increasing these measures in addition to developing new treatment evolution and response markers for patients in the chronic phase, and new drugs to treat the disease.
Chagas disease is endemic to Latin America and is a global health challenge due to migration from countries in the region. Transmission via insect is mainly found in Bolivia, which has the highest number of cases. There are also infections in north-west Argentina, Peru, Paraguay, Ecuador, Nicaragua and southern Mexico. Outside these areas it is more commonly transmitted from mother to child.
Most patients with Chagas disease do not show any symptoms, which makes it difficult to detect. The disease develops in two phases:
This disease affects six to seven million people, but 60 million are estimated to be at risk of infection. There are 11,000 cases in Catalonia.
There are currently two drugs that are used to treat Chagas disease: Benznidazole and Nifurtimox. Specific treatment is needed to address any cardiac and/or gastrointestinal complications that may arise.
Since 2011, Catalonia has implemented the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American women and their babies”. This programme allows possible congenital cases to be detected, and at the same time actively screens blood and organ donations from donors.
This is a heart condition affecting babies in which the two main arteries of the heart (the aorta and the pulmonary artery) originate in the right ventricle. This kind of disorder may be associated with other alterations such as ventricular septal defect (VSD) or pulmonary valve stenosis.
A ventricular septal defect (VSD - or interventricular communication) is a hole in the partition separating the two ventricles. Communication between them is necessary, as it allows oxygenated blood from the left chamber to pass to the aorta.
In the case of double outlet right ventricle (DORV), however, oxygenated and unoxygenated blood becomes mixed, meaning the oxygen level is lower than normal. Different corrective measures must be taken depending on the characteristics of the condition.
Besides this, some children may have pulmonary valve stenosis, which is when there is an obstruction in the blood flow to the lungs.
Double outlet right ventricle is diagnosed via echocardiogram. It is increasingly detected prenatally or when a baby has just been born. In some cases, imaging or catheterization techniques have to be undertaken to look at the DORV in detail to determine the most appropriate surgical procedure.
DORV and related damage is usually surgically repaired during the first six months of life. In this procedure, the left ventricle is connected to the aorta, and the septal defect is therefore closed off.
In babies without pulmonary stenosis, a band is also usually fitted around the pulmonary artery to reduce the excessive pulmonary blood flow.
A different procedure has to be carried out on babies with pulmonary stenosis. In this case, the valve has to be repaired with a patch enlargement, or in more serious cases, using a conduit. If stenosis is severe, it may be necessary to perform intermediary surgery to increase lung flow and reach an adequate level of oxygen in the blood before the final repair can be carried out.
Most patients need no further intervention during their lifetime, apart from children who have been given corrective surgery such as a conduit into the pulmonary artery. In this case further surgery will certainly be required. Despite this surgery, most children treated will be able to lead a normal life, although they will have to be monitored by a cardiologist.
They are inherited diseases affecting the heart and aorta. A range of diseases are included such as myocardiopathies, conduction diseases, and genetic aortopathies.
Myocardiopathies are diseases of the myocardium, the muscular tissue of the heart. There are several types of myocardiopathy: dilated, hypertrophic, non-compaction, arrhythmogenic dysplasia of the right and/or left ventricle and restrictive. Imaging techniques are used for diagnosis. Medical treatment and, where necessary, fitting a resynchronisation defibrillator can avoid complications and improve patients’ quality of life.
Pharmacological provocation tests are important for diagnosis of conduction diseases such as Brugada syndrome, long QT and short QT syndrome and catecholaminergic polymorphic ventricular tachycardia. Treatment is medical and sometimes a defibrillator device may need to be fitted.
Inherited aortopathies, or diseases of the aorta, such as Marfan syndrome, Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome require imaging techniques to diagnose them accurately. Medical treatment and elective surgery prevent complications arising.
Symptoms of inherited heart disease are:
The prevalence of these disorders varies between 1/500 for hypertrophic myocardiopathy, 1/5,000 for conduction disorders and 1/5,000-10,000 for Marfan syndrome. Some of these diseases can therefore be said to be rare.
Diagnosis is reached using:
Treatment may require aortic surgery, the use of a resynchronisation automatic defibrillator implant or septal ablation.
Knowing the family medical history is important for all inherited heart diseases. Family screening can detect undiagnosed cases and lead to early treatment, and in some cases, preimplantation diagnosis.
Cardiology, General Hospital
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