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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.
In Catalonia, around 600 babies are born every year with congenital heart disease (between 5 and 12 per 1,000 live babies), of which about 25% will need surgical care during childhood.
Thanks to technological advances and improvement in surgical techniques, the survival rate of these patients has increased in recent years. This does mean that more and more children are growing up to develop cardiac insufficiency and suffer heart failure, meaning they will need a heart transplant. In addition, the rate of myocardiopathies, meaning genetic or acquired diseases that affect the strength of the heart muscle, is 1 per 100,000 inhabitants, and about 40% of children die within two years of diagnosis of the disease.
The Adolescent and Adult Congenital Heart Disease Unit (UCCAA) is the result of a collaboration agreement between Vall d'Hebron University Hospital and University Hospital of Santa Creu i Sant Pau, to bring together the efforts, resources and experience of the two hospitals with the greatest tradition in treatment of these diseases in a single level three congenital heart disease unit for adolescents and adults.
In order to group together outpatient care for congenital heart disease into a single area, the UCCAA Unit outpatient clinic is located in the Maternity and Children's Hospital, next to the Paediatric Cardiology clinic. This common area allows us to share workstations, databases and tools (3D ultrasound) and makes transfer and continuity of treatment simple, from paediatric age to adulthood, for what is a congenital and lifelong pathology.
Patients who require admission do so at the General Hospital, and stay on the Cardiology and Cardiac Surgery ward. Depending on their clinical circumstances, some of these adult patients with congenital heart disease must be admitted onto special wards:
Patients in critical condition: Coronary and Intensive Cardiological Care Unit of the Cardiology Department.
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:
The Arrhythmia Unit has two theatres. One of them is completely dedicated to procedures such as:
The unit also has specific clinics to treat and monitor patients with cardiac arrhythmia. These include consultations about devices and five clinics dealing with the following matters:
In 2019, the unit carried out:
The Arrhythmia Unit works jointly with the Paediatric Cardiology Department on invasive treatment of cardiac arrhythmia in paediatric patients.
People can suffer from slow arrhythmia or fast arrhythmia. This often occurs in hearts affected by a cardiac disease, but also occurs in hearts with a normal structure.The most common fast arrhythmia is atrial fibrillation, which requires medical treatment and, occasionally, ablation with a catheter. This is a safe procedure and commonly gives good results.The most common slow arrhythmias are those that appear with age. They are caused by degeneration of the heart’s electrical system. They usually require a pacemaker to be fitted.
The Arrhythmia Unit also carries out common non-invasive procedures such as:
The Arrhythmia Unit has extensive experience in researching the field of cardiac arrhythmias. It has published many times in specialist journals. The following research lines are highlights:
The Arrhythmia Unit's team of professionals take active part in academic education and practical training on the medicine and nursing degree courses. Cardiology residents usually spend time at the unit, along with residents in other specialities at the hospital. Residents from other hospitals in the Vall d’Hebron area and from other Spanish, European and Latin American hospitals also do so, if they are interested in training on the treatment of arrhythmia diseases.
The unit's team regularly takes part in training activities outside the hospital. The unit offers the following specific, staff training courses periodically:
The Arrhythmia Unit has a coordinator and four assistants. They work with the nursing staff, consisting of seven specialist professionals, who deal with caring for patients and doing the invasive electrophysiology treatments. They also monitor patients with intracardiac devices on-site and remotely.
The Anaesthesia, Resuscitation and Pain Management Department provides comprehensive perioperative care for surgical patients, from their arrival to the hospital until they return home. We offer care with more than 30,000 operations a year.
At the Anaesthesia Department, our mission is to offer comprehensive perioperative care, from the moment the patient arrives at the clinic or hospital, during the operation and beyond.
We have a staff of professionals specialised in all areas, essential for the large number of transplants of all kinds that are performed at our Hospital. We should also mention our nursing team specialising in anaesthesia, who begin their career at our Department.
The Department is divided into four main geographical and care areas:
The Department encompasses several key working areas:
Outpatient preoperative consultations work with primary care in processes such as obstetrics and endoscopy labs. Preparatory and postoperative care are of vital importance in establishing a good flow of patients, especially in areas such as resuscitation.
Patients attended to by the Pain Unit have often been treated previously. This is due to the nature of their problem and the difficulty in solving the symptoms they suffer. This is why we have established fast-stream resolution and care schemes using a mobile application. Patients can inform us from their home of the degree of pain, thus improving their quality of life.
At the Neonatology Department, we are committed to offering personal, individualised care focussed on the development of the baby and encouraging family participation as a key element in the process.
At the Neonatology Department, part of the Maternity and Children's Hospital at Vall d'Hebron University Hospital, we are a reference centre for various techniques improving the lives of infants, such as: foetal therapy, ventilation needs and specific invasive respiratory assistance, surgical interventions and cardiac malformations. In addition, we use special blankets in the incubators that protect from noise and light, and we reduce the noise and level of lighting in the room. We aim to maximise the parents' participation in their baby’s care, in close collaboration with our nursing staff. We favour an open-door policy and promote skin-skin contact, or the kangaroo care method, for mothers and fathers, as well as breastfeeding.
Parents are welcome to enter the Neonatology Unit 24 hours a day to be with their child, and have a room available where meetings are also held so they can share experiences with other parents and staff from the Unit.
All this means we have been certified as a centre for NIDCAP training (Neonatal Individualised Development Care and Assessment Program), which promotes an active role for parents throughout the process, with support from staff from our Department.
We collaborate closely with the Obstetrics Department and other specialists and departments involved in providing care before and after discharge, in order to guarantee continuity of care. In this field, we can highlight three pioneering programmes at the national level: the Siblings Project, the "Almost like home" programme and the “Space to talk” programme.
We are structured into the following healthcare areas:
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The Paediatrics Teaching Unit has extensive experience in training specialists. There are a total of 60 Paediatrics residents at Vall d’Hebron University Hospital, 15 per year. Over the last few years, Paediatrics at Vall d’Hebron has been the first choice for new residents, and in the 2017 exam session achieved the best results of any Spanish hospital. In addition to this, we receive residents from hospitals all over the world.
Pediatric training itineraries
Over the last few years, paediatrics at Vall d’Hebron has been residents’ first choice, and in the 2017 exam session achieved the best results of any Spanish hospital.
The Department has a Paediatrics Teaching Subcommittee, comprising twelve tutors and twenty residents overseeing the practical application of the training and its integration into healthcare activities. Thanks to the involvement of these professionals, we can ensure supervised completion of the training programme objectives.
This Teaching Unit comprises different healthcare departments and units, including the Paediatrics, Nephrology, Neonatology, Paediatric Oncology and Haematology, Intensive Care, Neurology, Endocrinology, Infectious Diseases, Allergies, Cardiology, Respiratory Medicine, Gastroenterology, and A&E Departments.
It is vital for residents to train in research methodology as this is necessary to take part in and develop research projects. From the second year onwards, we invite residents to carry out research work, and a minimum number of papers and publications is required in addition to their full cooperation in sessions within the Department.
Why specialise at Vall d’Hebron?
The Neurosurgery Teaching Unit is led by the Neurosurgery Department, with participation from Neurology, Pathological Anatomy, Clinical Neurophysiology, Intensive Care and Neuroradiology.
Neurosurgery training itinerary
The Plastic, Cosmetic and Restorative Surgery Teaching Unit is led by the Plastic Surgery and Burns Department, who work in a team with General Surgery, Thoracic Surgery, Vascular Surgery and Neurosurgery. The unit also participates in plastic surgery services in other public and private hospitals.
Training itinerary for plastic, aesthetic and restorative surgery
First-year residents rotate through the Burn Unit, Traumatology, General Surgery and the ICU of the Traumatology Hospital. There are three months of rotation in each service. During the second year, rotations are carried out by the different subunits of the Service (Breast Reconstruction, Pediatric Plastic Surgery, Burns, Tumor Unit, General Plastic Surgery). On the fourth or fifth year, rotation to other hospitals is facilitated based on personal interest, and in the fifth year, a rotation is made through Cosmetic Surgery.
The Vall d’Hebron Research Institute (VHIR), has its own animal facilities where students can practice microsurgery. Students may also study in the Burns Unit and take part in national and international publications and presentations.
The residency in Physical Medicine and Rehabilitation allows you to gain experience of clinical practice in rehabilitation; an area where all aspects of the specialisation are considered, from orthopaedics, neurology, spinal cord injuries, infant rehabilitation, amputations, lymphoedema, pelvic floor and speech therapy; to pulmonary rehabilitation and community-based treatment for back pain and burns.
We are an active research centre with a high number of publications, at the same time as participating in several national and international programmes. We have also received awards at different conferences in the specialisation.
The Physical Medicine and Rehabilitation teaching programme includes key aspects for research, such as training in clinical epidemiology and clinical research methodology. In addition, our residents undertake research competence courses to complement their practical work.
The Paediatric Surgery Department at Vall d’Hebron University Hospital is a reference in Catalonia for the treatment of most paediatric surgical problems and in the rest of Spain for specific procedures. Our mission is to care for paediatric patients with surgical concerns.
Pediatric Surgery Training Itinerary
Paediatric Surgery is a discipline that covers a wide range of pathologies, from congenital, acquired, malformation, infectious and tumoral conditions, including thoracic, abdominal and genitourinary issues.
Our involvement in patient care spans from before birth (foetus, prenatal period) through to late adolescence.
To provide the highest quality, our service is structured into different subspecialities:
This innovative structure allows us to achieve a high level of super-specialisation and expertise in a specific area of modern paediatric surgery, which further benefits our paediatric patients and ensures a higher quality of care.
Our Paediatric Surgery department was the first in Spain to introduce a Foetal Surgery Programme, forming part of the multidisciplinary Foetal Medicine programme.
Similarly, we were the first hospital in Spain to perform paediatric transplants, kidney transplants from 1981 and liver transplants from 1985, including being the first to carry out a reduced liver transplant in 1987 and the first ‘split’ liver transplant in 1992. Our Hospital and our Department remain directly involved in the liver and kidney transplant programmes, which are among the highest volume and best-performing in the country.
We are committed to high-complexity surgery, introducing increasingly minimally invasive techniques to various paediatric-age groups, including neonatal surgery, and even venturing into foetal surgery. Among these minimally invasive techniques, we incorporate robotic surgery. Starting in 2009, we were the first paediatric hospital in the country to develop a robotic surgery programme.
Our department is currently accredited by various national and international benchmarking programmes: CSUR (Centres, Services and Units of Reference of the Ministry of Health) for Neuroblastomas, Childhood Sarcomas, Paediatric Liver Transplant, Paediatric Kidney Transplant, Bladder Exstrophy and Epispadias.
We are also ‘Full-Members’ of various ERN (European Reference Networks) such as ERNICA and EUROGEN, as well as Paediatric Oncology and Erythropathies.
In 2012, we received the Certificate of Hospital Accreditation for Specialist Training in Paediatric Surgery from the European Board of Paediatric Surgeons, with the endorsement of the UEMS, as a centre of excellence for the training of paediatric surgeons and in 2023, we were again re-accredited as a Centre for Training in Paediatric Surgery.
Our programme allows residents to gain comprehensive training in all areas of paediatric surgery, which, unlike programmes at other centres, encompasses everything from organ transplants to foetal surgery, including neonatal, oncological, thoracic, digestive and urological surgeries. Training emphasises the most advanced minimally invasive techniques, including robotic surgery. Our simulation laboratory for minimally invasive surgery enables our residents to train in an appropriate and safe environment.
During the first semester, residents undergo adult general and thoracic surgery training. Subsequently, they join our department, rotating through the various subspecialities according to their training programme. During on-call shifts (4-5 per month), the resident is accompanied by a senior doctor who is physically present. During continuous care, paediatric surgical emergencies are covered, and they participate in the paediatric polytrauma care programme. During these shifts, we encourage the resident’s autonomy in surgical decision-making and their proficiency executing the various surgical techniques performed. Furthermore, residents are integrated into paediatric transplant programmes (liver and kidney).
The training pathway for residents in our centre ensures learning across all paediatric surgical subspecialities, encompassing everything from outpatient surgeries to highly complex surgeries such as intricate oncological surgeries, complex anorectal malformations and solid organ transplants. Additionally, there is a six-month period where optional rotations can be undertaken, where the resident can choose from options available in our centre including: paediatric plastic surgery, paediatric cardiovascular surgery, paediatric neurosurgery, paediatric anaesthesia, paediatric maxillofacial surgery.
Continued training sessions are held between members of the department and external specialists:
During the final year of training, a rotation to international centres of excellence is encouraged. Throughout the residency, clinical and laboratory research is promoted, encouraging the presentation of papers at national and international conferences and publications.
Furthermore, training courses deemed necessary for the speciality are provided during the residency:
Throughout rotations in various units, the relevant team provides information on courses and subspecialist conferences that are more appropriate to attend and/or submit papers. There are also specific courses which, depending on the resident’s interest, can be optional or mandatory.
In the field of research, residents are encouraged to participate in the department’s active research initiatives and new research that may or may not be related to these research lines and which may result in the pursuit of a doctoral thesis.
Currently, at the Vall d’ Hebron Research Institute (VHIR) we maintain several established paediatric research lines in experimental surgery, specifically focusing on foetal surgery. In 2015 we created the Bioengineering group, Cellular Therapies and Surgery in Congenital Malformations, which is currently researching prenatal treatment of spina bifida and congenital diaphragmatic hernia. Moreover, among other projects, we have conducted research on amniotic band syndrome, gastroschisis, oesophageal atresia and bladder augmentations. These translational research programmes have enabled patients to benefit from them, notably the FETO techniques (foetal tracheal occlusion in the serious congenital diaphragmatic hernia) and the prenatal repair of the myelomeningocele, initially by open surgery and since 2015 via fetoscopic methods.
Regarding clinical research, the first multicentre randomised controlled trial on the treatment of parapneumonic empyema stands out, comparing video-assisted thoracoscopy to drainage and use of fibrinolytics, subsequently published in the journal Pediatrics. Additionally, there are numerous clinical research lines across all units, with publications in national and international journals.
At the same time, we collaborate with other research teams, particularly in the field of paediatric oncology, as well as in collaborative studies and international multicentre studies. Experimental research groups:
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?
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