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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. Firstly, we find genetic disorders such as Marfan syndrome, bicuspid aorta, etc. And on the other hand, we find hypertension or atherosclerosis. It is therefore very important to have a genetics unit, to take into account family history and risk factors, excellent support through imaging techniques (echocardiography, CT and MRI) and a good cardiovascular surgery team. The Multidisciplinary Aortic Diseases Unit at the Vall d'Hebron University Hospital was set up because most of these requirements are already met.
For 20 years now we have been monitoring all sick people receiving medical discharge after having overcome an acute aortic syndrome, which is a risky condition that can lead to very serious complications. We are one of the leading groups in the protocolised monitoring of this disease. This experience has provided us with a unique knowledge of this disease.
More recently, our interest has expanded to genetic or congenital diseases that may affect the aorta. An important turning point was the creation of the Marfan Syndrome Multidisciplinary Unit in 2009. This Unit, a leading centre in Catalonia, has the purpose of offering patients integral assistance for all their related problems.
To improve the care provided for aortic pathology in terms of prevention, diagnosis and treatment.
To inform specialists and general practitioners when the disease should be suspected: family history, genetic diseases, valvular heart disease, atherosclerosis. Proper diagnostic strategy and control of risk factors (ADHD, smoking, etc.)
Appropriate indications, selection of cases, and intraoperative support for optimisation of surgical or endovascular treatment, in both urgent and scheduled actions.
The CCU is a hospital unit dedicated to treating patients with critical cardiovascular conditions. It was created in 1971 as a medical-surgical unit to admit patients suffering acute myocardial infarction and other acute cardiovascular medical pathologies and to offer post-operative care for patients following cardiac surgery. In 1989 it was divided into two and the current took charge of patients with medical pathologies and became part of the Cardiology Department. The CCU has 10 hospital beds for critical patients and 4 for semi-critical patients, and plays an important role in healthcare, with around 1000 admissions per year. Two thirds of admissions are due to acute myocardial infarction and the rest are due to acute cardiovascular syndromes such as heart failure or non-ischemic cardiogenic shock, resuscitated cardiorespiratory arrest, and other severe tachyarrhythmia and bradyarrhythmia. Acute aortic syndrome, cardiac tamponade and after complex or complicated structural or electrophysiology procedures.
The reputation of Vall d’Hebron Hospital Campus as a leading centre for pathologies such as adult congenital heart defects and acute aortic syndrome means the Unit admits a relatively high number of patients with these conditions. In terms of patient severity, the approximate number of patients admitted following resuscitated cardiorespiratory arrest is 50-60 per year, and at the time of admission between 65 and 75 patients present with cardiogenic shock and 60-70 are receiving invasive mechanical ventilation. The team is comprised of four cardiologists and a nursing supervisor in addition to six nurses plus assistants, security and administrative staff on each shift. A team is on duty at the hospital outside working hours and 24-hours a day over national holidays and weekends.
The CCU is completely integrated into the Cardiology Department, one of the most prestigious centres in the country, which enables us to constantly enhance our professionals’ training through daily clinical sessions and interaction with colleagues from the department who have extensive experience in their fields. There is also fluid interaction with professionals from other specialisations at the hospital to guarantee our patients receive the very best care.
Equipment and portfolio of services
Teaching
Research
The CCU takes part in numerous studies and clinical trials with private or competitive public financing and leads a significant number of them. Over the last five years, its members have authored or co-authored 80 articles indexed in PubMed, with a total impact factor of 338. The Unit’s main lines of research are:
Guides for coronary patients:
Related professionals
Dr José A. Barrabés Riu, head of section
Dr Rosa-Maria Lidón Corbí, senior doctor
Dr Antonia Sambola Ayala, senior doctor
Dr Jordi Bañeras Rius, senior doctor
Ms Mercè Andorrà Lòpez, nursing supervisor
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:
Echocardiography laboratoryEach year, this services carries out:
Transoesophagal echocardiogram guiding for heart valve surgery or structural proceduresOver the past few years, this technique has been included into new procedures to guide the cardiac surgery team. For example, it is used in the aortic valve percutaneous implant, percutaneous repair to the mitral valve, closing the left atrium and closing intracardiac shunts.
Basal and stress cardiac MRI, cardiac and coronary CAT scans and cardiac and large vessel CT angiographyThe unit carries out studies on the diagnostics using images of the myocardial, coronary, pericardial and aorta disease. These are done in collaboration with the Radiology Department. The unit is certified by the European Cardiology Society.
The Echocardiography and Cardiac Imaging Unit was formed in 1975, within the Cardiology Department. It was responsible for phonocardiograms - a graphic record of cardiac sounds obtained from a stethoscope - and echocardiograms - an ultrasound of the heart. With the passage of time, and technological advances, the unit has brought in other techniques in the field of cardiac imaging, such as:
These advances mean that the unit’s team are specialists in each one of the technologies.
The team works together with the Arrhythmia Unit, the Congenital Heart Disease Unit and the Genetics, Cardiac Surgery, Vascular surgery and Paediatric Cardiology departments. Daily collaboration enables advances in the field of heart disease from the clinical and scientific research points of view. The unit also has the following specialist sub-units:
Familial heart diseasesA significant proportion of the people seen in the unit suffer from some kind of familial cardiomyopathy. This is a disease caused by a defect that is genetic in origin, that causes abnormal development of the heart. In some cases it causes exaggerated thickening of the walls and, in others, dilation of the cavities. In both cases abnormal functioning of the heart occurs. Advice from other specialists in genetics and arrhythmia is essential to treat this disease. Collaboration with paediatric cardiology experts is also needed. Treatments include medicines and inserting intracardiac devices that enable the heart to work better and even, in serious cases, prevent sudden death.
Complex and genetic aortic diseaseThis is an alteration to the wall of the aorta, which is the body’s main artery. It may increase in size or become more fragile. These changes may cause the artery to rupture or fissure and put the person’s life at risk. The change must be controlled and, if necessary, a surgical or endovascular procedure should be carried out.
Valve diseasesOne of the most frequent appointments at the unit is for disease in one of the four heart valves. The disease is diagnosed with an echocardiogram. The heart’s valves may deteriorate due to ageing, infectious illnesses or some congenital cause. The deterioration may cause narrowing of the valve opening. This prevents the blood from circulating properly. It may also cause incorrect closure which makes the blood go backwards, instead of moving on in the blood system. Currently, early diagnosis, follow-up and suitable treatment enable a valve diseases to be solved or improved to a considerable extent.
The main treatment for valve disease is the surgical implant of a mechanical or biological prosthesis. Over the last decade implantable prostheses and devices have been developed to repair valves using catheterisation. This is a simple technique that is minimally invasive.
Transthoracic echocardiogramThis studies the morphology and function of the heart using ultrasound. It is a non-invasive test, with no side effects and highly effective in diagnostics using imaging in cardiology. It enables a detailed study to be made of the heart walls’ mobility, the valves and the blood flow within the heart. Echocardiography currently uses 3D technology. This allows the heart to be studied from a more real perspective and improves the diagnosis.
Transoesophagal echocardiogramThis test also studies the morphology and function of the heart using ultrasound. In this case, it is done using a probe in the inside of the oesophagus. The patient needs to be sedated. The advantage of this test is the high resolution image it gives, which is much higher than conventional echocardiography. For this reason, where there are doubts about a diagnosis, both are done.
Transthoracic stress echocardiogramThis test also studiesthe morphologyandthe function of theheartusingultrasound. In this case,it is done with the patient pedalling a staticbicycle.It enables assessmentof the increase in coronary blood flowin patientswithischaemiccardiopathy.During the test, theelectrocardiogram andbloodpressurearecontinuouslymonitored.Thetestprovidesinformationabout possibleobstructions ofthecoronaryarteriesand, in some cases,aboutthe function of thevalves.
Multi-detector computed tomographyThis technique uses X-Rays to provide multiple images of cuts or sections of the body, including the heart. A computer program puts the images obtained together again and creates a 3D view of the heart which enables precise exploration of the coronary arteries, the aorta, valve prostheses or abnormal intracardiac communications.
Cardiac MRIThis technique also provides images of sections of the heart and the main arteries in the body. It does not use X-Rays. However, it is not advisable for patients with chronic kidney failure or implanted heart devices. It provides information about the heart’s structure and allows precise imaging of its tissue. It determines whether the heart’s tissue is made up of, or occupied by, dead cells, fibrous tissue, fat or liquid.
The research group at the Echocardiography and Cardiac Imaging Unit has an excellent reputation in its field in Spain, Europe and worldwide. The research programme mainly receives external, highly competitive finance. It works to get to know more about heart disease and, therefore, improve people’s health care. The research group works with some organisations, such as the association of patients affected by Marfan’s syndrome (SIMA) and the José Durán Spanish Sudden Death Society.
Research is an area of work that is well consolidated and multi-disciplinary. It creates original ideas and moves forward with technological improvements. Over the past few years, the group's engineering team has developed several innovative clinical imaging analysis tools to get to know about and solve important problems. It has also published several articles in scientific journals and has taken part in several clinical trials, and multi-centre logs and research. The group also actively collaborates in projects associated with Barcelona University and Pompeu Fabra University. The unit is currently coordinating:
The members of the unit are a part of the European Cardiology Society’s Aortic Disease Group, the European Association of Cardiovascular Imaging (EACVI) and the American Society for Cardiovascular Magnetic Resonance (SCMR).
The training programme includes:
The individual members of the unit regularly take part in training activities outside the hospital. They run masters courses in cardiovascular disease, and collaborate on them. Each year the unit organises two echocardiogram courses and a meeting on cardiac MRI and CAT. 200 experts from all over the world take part in these events.
The Echocardiography and Cardiac Imaging Unit is made up of medical, nursing, engineering and administrative personnel, as well as technical and support staff. It works closely with other sections of the Cardiology Department and with the other hospital departments. Furthermore, over the past few years, three people with a degree in engineering have joined who are specialists in fluid dynamics.
The medical staff consists of a coordinator and seven assistants. The nursing team consists of four specialist experts. The technical team has four experts, qualified with a specific masters from the Spanish Cardiology Society.
The Institute for Diagnostic Imaging uses the most advanced techniques, and contributes to generalising the application of this type of diagnostics to improve care and the quality of image-based explorations and diagnoses.
The Institute for Diagnostic Imaging (IDI) is a state-owned company that is affiliated with Catsalut, and has one of its centres at the Vall d'Hebron Hospital. IDI manages, administers and executes image diagnostic services and nuclear medicine services.
At our hospital, we conduct explorations using: magnetic resonance imaging, computed tomography, nuclear medicine, PET-CT, angiography, ultrasound, mammography, densitometry, conventional radiology, and orthopantomography, among others. This centre is also charged with helping with technological innovation projects, developing research and promoting teaching, thus contributing to scientific and social progress.
IDI and Vall d'Hebron are committed to innovation. In this context, we have PET-CT equipment that allows us to analyse molecular aspects of diseases such as cancer and neurological or cardiovascular disorders. This equipment, which can carry out between 4,000 and 5,000 tests a year, also offers the possibility of introducing new radiopharmaceuticals that improve the management of diseases with a specific molecular profile.
General Hospital
Traumatology Unit
Maternity and Children's Hospital
The Digestive System Department caters for patients with digestive diseases with an emphasis on technical and human excellence.
The mission of our Department is to improve the quality of life of patients with digestive diseases, through the development of knowledge (research), and the transmission of knowledge and values (training).
The activity of the Department includes:
Hospitalisation Ward: this offers care services to the population in the surrounding SAP Mountain area and serves as a reference unit in Catalonia for the referral of patients with hard-to-diagnose/treat patients from hospitals in the Barcelona province (Mollet Hospital, Granollers Hospital, Calella Hospital, San Rafael Hospital, Vic General Hospital) or from level three hospitals from other parts of Catalonia (such as Arnau de Vilanova Hospital, in Lleida, or Josep Trueta Hospital, in Girona). It has 24 beds for hospitalisation for patients admitted with digestive diseases.
Outpatient Clinic: care and follow-up of the most complex outpatients from each area, from Monday to Friday.
Accident and Emergency: care by a Digestive System specialist available 24 hours a day, 365 days a year.
Crohn’s Colitis Unit: provides social healthcare and control of patients with inflammatory bowel disease, both face-to-face and digitally. It is part of a comprehensive care plan for patients with Crohn's disease and ulcerative colitis, with a particular focus on the changes they may undergo biologically, psychologically and socially. Its role as coordinating centre of the National Network of Crohn’s Colitis Care Units is directed by two medical specialists, a nurse and a research coordinator.
Motility Unit: helps patients with digestive disorders via a functional hospitalisation unit and the Functional Test Laboratory, where diagnostic tests and treatments are performed for patients with digestive conditions. This Unit enjoys a high level of national and international prestige and conducts studies of intestinal function both in terms of motility and malabsorption. This unit is part of the European Centre for Gastrointestinal Motility.
Bleed Unit: this Unit deals with patients with severe digestive haemorrhaging and has 4 semi critical beds for the treatment and diagnosis of acute (high, low or hidden) digestive bleeding. Admission is indicated in cases of severe digestive haemorrhage requiring continuous monitoring and which may therefore not be treated on a conventional ward. Direct patient care is the responsibility of the medical staff assigned to the Bleed Unit and they coordinate the participation of the rest of the team necessary who come from the following units: Digestive Endoscopy Unit, Anaesthesia Department, A&E Department, Surgery Department, Diagnostic Imaging Unit and Interventional Angioradiology Unit.
The Pancreatic Unit: addresses a high number of patients with acute pancreatitis, recurrent pancreatitis and chronic pancreatitis (200 patients), as well as patients with adult cystic fibrosis (160 patients) and patients suffering from pancreatic cystic lesions.
The Digestive System Department’s teaching activity includes a degree at the UAB and the training of specialists in the Digestive System as part of the medical residents programme. The Department also participates in continuing education programmes for internal and external residents from the European Training Centre of the European Board of Gastroenterology and Hepatology.
The Digestive System Department carries out significant research as part of the Physiology and Digestive Physiopathology Research Group of the Vall d'Hebron Research Institute, and as part of the Gastrointestinal Inflammation and Neurogastroenterology Division of CIBERehd. We are also recognised by the Catalan Government’s AGAUR programme.
Care by a Digestive System specialist is available 24 hours a day, 365 days a year.
Our mission is to restore the health of all critical or potentially critical hospital patients using advanced monitoring and support systems. Our work with patients is carried out both within the Intensive Care Unit and outside it, 24 hours a day, every day of the year. We have the knowledge and technical means to treat the most complex patients.
The Intensive Care Unit (ICU) treats 1,200 of the most complex critical patients every year. Additionally, the Department supports other serious patients not in the ICU but who require assessment from specialists in intensive care medicine.
The Intensive Care Medicine Department leads many hospital programmes, such as: Code Sepsis, care for cardiorespiratory disease and the ECMO programme, and collaborates actively in the Organ Donation and Transplant Programme.
We also bring together different professional groups (doctors, nurses, administrative staff, orderlies, cleaning staff, etc.), resulting in a multidisciplinary department in which teamwork is essential. Our goal is to humanise the ICU to make it an environment in which professionals, families and patients are comfortable.
The Intensive Care Medicine Department has its own research group at the VHIR Research Institute, in the area of Infectious Diseases: the SODIR Research Group (Shock, Organic Dysfunction and Resuscitation).
The SODIR has 2 areas of research:
SODIR has created a Clinical Research Unit to take part in clinical trials sponsored by the industry, and supports competitive research projects. The Unit is made up of nurses and doctors dedicated exclusively to clinical research, and currently has 11 active clinical trials.
Teaching activity at the Intensive Care Medicine Department encompasses the teaching of undergraduate, postgraduate and continuing training of professionals in treating critical patients. We have been accredited to train 3 residents in intensive medicine annually. We organise several yearly courses, such as: Ventilung, Ecolung, ECMObarna and SedUCI.
The General Hospital Accident and Emergency Department handles emergencies for all medical and surgical specialties for adults, regardless of the severity. We have doctors specialising in internal medicine and intensive care medicine, oncology and haematology, and surgical specialties, as well as doctors on call 24 hours a day.
The General Hospital Accident and Emergency department is made up of:
We also have an Observation Ward with 55 beds that has been converted into a hospitalisation unit where patients who have been treated wait until they are transferred to a different hospitalisation ward or another centre. There is also a Short-Term Unit with 16 beds for short-stay patients who are to be hospitalised for less than 4 days.
Accident and Emergency provides care in cases of Code Stroke, Code Heart Attack and Code Sepsis, among others, in coordination with the Emergency Medical Services (EMS) to provide immediate care in case of emergencies. We also work in close collaboration with Transplant Coordination.
Vall d'Hebron University Hospital is one of the most active centres in organ and tissue donation, and that is why it is home to multidisciplinary teams who guarantee a high level of health protection, both for the donor and the recipient. One final highlight of the A&E portfolio at the General Hospital is the Diagnostic Imaging Department, with CT scan and ultrasounds available 24 hours a day, and interventional angiology.
The Ophthalmology Department at Vall d’Hebron University Hospital offers integrated care to all those with conditions that affect eyes and eye attachments. We act as a national reference in various ophthalmological pathologies, attending patients from both Catalonia and the rest of Spain. This care work is complemented by important teaching and research activity, which allows us to remain at the forefront of our specialty.
The aim of the Ophthalmology Department is to put all the material and human resources at our disposal into improving the eye health and quality of life of our patients.
The Ophthalmology Department's activity is conducted at various locations, depending on the different care activities, all of which are coordinated and directed by Dr José García-Arumí, Head of Department:
In turn, the Department's care work is structured into different sections, corresponding to each of the ophthalmology sub-specialties. In order to be able to offer more specialised care, in the context of a tertiary level hospital, we have a large team of professionals who are experts in the different sub-specialties:
All the above sections interact with other departments or units at Vall d'Hebron Hospital in order to coordinate and agree on diagnostic and therapeutic decisions for patients who present pathologies involving different medical specialties. This is the case of the multi-disciplinary committees (Tumour Committee, Transplant Committee...), direct contact with other care services in specific cases (maxillofacial surgery, traumatology, plastic surgery, neurology, paediatric specialties, etc.), close contact with services involved in diagnostic (microbiology, pathological anatomy) or therapeutic (Blood and Tissue Bank) tasks and the participation of a doctor specialised in internal medicine in the tasks of diagnosis and treatment of ocular inflammatory processes (Dr Antonio Segura).
The Ophthalmology Department is a Teaching Unit of the Autonomous University of Barcelona (UAB). The academic chair is Dr José García-Arumí, Head of the Ophthalmology Department. In turn, several members of the Department are professors (Dr Tirso Alonso Alonso), associate professors or interns at the UAB.
The teaching activity of the Ophthalmology Department includes:
The protocolisation of clinical measures, patient follow-up and collecting the corresponding data has led to the publication of various works in high-prestige national and international journals and the participation in clinical trials and research studies on the most recent therapeutic techniques in the different sub-specialties.
The basic research group in Ophthalmology, made up of an interdisciplinary team of clinicians and basic researchers, focuses its activity on research into new therapies for the treatment of the main neurodegenerative diseases of the retina (such as diabetic retinopathy, age-related macular degeneration and retinitis pigmentosa), ocular surface pathologies (dry eye syndrome, herpes keratitis and neurotrophic ulcers) and the repercussions at eye level of different systemic treatments.
The projects currently being conducted deal with studying different therapeutic strategies, such as cell therapy using stem cells, gene therapy for the expression of curative genes and pharmacological therapies with antiangiogenic factors and antioxidants. These research projects mainly involve basic research, conducted at the Ophthalmology Laboratory located at Vall d'Hebron Research Institute (VHIR), as well as the development of preclinical trials, using animal models for experimentation, which are conducted at the VHIR Animal Facility. All these products have led to multiple presentations and publications in high-impact journals.
The Neurology Department treats neurological patients, both in primary care centres and at our renowned hospital centre. We have a specialist stroke area (strokes with cerebral blood flow disorders) to treat patients in the acute phase.
The Neurology Department at Vall d'Hebron University Hospital is made up of five specialised units: the Neurovascular Unit, the Dementia Unit, the Epilepsy Unit, the Neuromuscular Unit and the Cephalea and Neurological Pain Unit.
We offer patients all the latest neurology resources, such as emergency neurological care by our expert on-call neurologists. We are home to super-specialist neurology units. We are responsible for quality in the neurological care provided, not only in the hospital, but throughout the entire health area where we are a reference centre.
We have links to the Faculty of Medicine at the Autonomous University of Barcelona and we are responsible for covering undergraduate and postgraduate neurological studies. The Department is accredited for teaching neurology, and we train resident medical interns specialising in neurology. We are a very active department in pursuing clinical and experimental research with a clear translational vocation to apply knowledge from basic research to the prevention and treatment of real clinical cases.
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.
Outpatient visits to the UCCAA Unit take place in the Outpatient Clinic of the Maternity and Children's Hospital, next to the Paediatric Cardiology Department, meaning we can group outpatient care for cardiology of congenital heart disease in a single area. This means that we can share work stations, databases and tools (the ECO 3D) and it makes the transfer and continuity of treatment simple, from paediatric age to adulthood, for what is a congenital and life-threatening disease.
Patients who require admission are directed to the General Hospital, and stay in the cardiology ward. Depending on their clinical circumstances, some of these adult patients with congenital heart disease must be admitted onto special wards:
In parallel with these services, there is also a clinic for reproductive counselling for women with congenital heart disease. This clinic is a part of the Adolescent and Adult Congenital Heart Disease Unit (UCCAA), carried out jointly with the Gynaecology Department at the Outpatient Clinic of the Maternity and Children's Hospital. There, a cardiologist and a gynaecologist/angiologist, experts in congenital heart disease, work together to analyse the patient depending on their individual clinical and heart disease condition and explore their chances of conceiving children. Their mission is to inform, evaluate and offer sexual health planning, discussing the reproductive possibilities of the patients living with congenital heart disease.
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