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In addition to providing multidisciplinary care for patients of all ages who suffer this condition, the objectives of Vall d’Hebron Hospital’s Hereditary Angioedema Unit include teaching and research in this field.
The Hereditary Angioedema Unit (UAEH) of Vall d’Hebron University Hospital’s Allergology Department has been treating patients with this disorder for more than 25 years.
UAEH outpatients are treated by allergology specialists in a multidisciplinary manner in the Outpatient Clinic in the Old Nursing School and in the Children’s and Women’s Hospital, ensuring transference and continuity of care from childhood through to adulthood for this genetic, lifelong condition.
The Unit is made up of popular, immunologists, geneticists, gynaecologists, maxillofacial surgeons, pharmacists and nurses, who are responsible for:
Depending on the type of care to be given to patients with diagnosed hereditary angioedema and their profile, they should be treated by the following divisions and/or units:
The specialists who work in the adult and paediatric allergology sections are responsible for treating patients aged 16 and under in the Children’s Hospital areas and subsequently facilitating their transfer and continuity of care with monitoring to the adult care departments in the Old Nursing School and the Allergology Day Hospital in the General Hospital.
The Hereditary Angioedema Unit (UAEH) offers an outpatient service to monitor patients with this disease: the Outpatient Clinic on the second floor of the Old Nursing School. Also, as it is a multidisciplinary unit, and depending on the type of patient (child, adult, pregnant woman), it provides care in a number of departments and units in the Children’s and Women’s Hospital, the General Hospital and A&E.
The nursing team specialises in education and specific care for patients with this disease.
Emergency care is provided at the Children’s Hospital for patients up to the age of 16 and at the General Hospital from the age of 17. The professionals who work in the A&Es have been trained to recognise the symptoms of this disease and to quickly provide its specific treatment.
When a patient needs a complex dental or maxillofacial procedure they will be assessed by the hospital’s maxillofacial surgeons and their operation will be organised with the suitable prophylaxis.
The Obstetrics, Foetal Medicine and Anaesthesia Departments have created a Working Unit for High-Risk Pregnancies for women with hereditary angioedema with the aim of monitoring the well-being of mother and child during pregnancy and of providing care during the delivery and postpartum period in accordance with a protocol specific to their type of hereditary angioedema and clinical situation. Care is also provided for high-risk postpartum cases.
In parallel to these services, there is also a reproductive counselling clinic for women with hereditary angioedema. The clinic is part of the Hereditary Angioedema Unit, and is that provided in conjunction with Gynaecology in the Outpatient Clinics of the Children’s and Women’s Hospital.
In this clinic an allergist and a gynaecologist combine their expertise to determine, in accordance with the patient’s clinical situation and type of hereditary angioedema, the possible effects of their having children. Their mission is to provide information and advice in relation to family planning and the reproductive possibilities of the patients living with this disease.
Oculoplastic and orbital surgery is a sub-specialism that treats the pathology related to the eye attachments, with four main fields of interest: orbital pathology, tear duct anomalies, anophthalmic cavity pathology and eyelid disorders.
The main characteristic of this field is its multi-disciplinary nature, due to the diversity of systemic diseases that may be involved. It is also an area that touches on other specialisms, including maxillofacial surgery, ear, nose and throat, plastic surgery and neurosurgery.
Treatment in this field often involves inter-relation with other medical specialisms, including endocrinology, internal medicine, radiology and oncology. We also provide medical and surgical care for oculoplastic pathology at the Children’s and Women’s Hospital.
We are a benchmark centre (CSUR) for orbital tumours nationwide and have set up an Orbital Tumour Hospital Committee to provide our patients with the best care and treatment.
This Section treats conditions affecting the optic nerve and Strabismus, a loss of ocular alignment.
This Section treats conditions affecting the optic nerve, whether secondary to intracranial hypertension, inflammatory/demyelinating, ischemic, infiltration-related (such as sarcoidosis), compressive, autoimmune, due to nutritional/toxic deficits, paraneoplastic or genetic, those affecting the visual field due to involvement of the visual pathway, whether cranial tumours, stroke, traffic accidents, infections (meningitis, encephalitis…) and those affecting pupil shape, size or reactivity.
In short, all those systemic or neurological entities that can cause visual dysfunction.
It is a multidisciplinary sub-specialty in which we collaborate with other hospital services, such as Internal Medicine, Neurosurgery or Neurology. We work particularly closely with the Neurology department of the Multiple Sclerosis Centre of Catalonia (Cemcat).
Strabismus is a loss of ocular alignment.
In our Department, we offer treatment by means of glasses, with or without prism, botulinum toxin or surgery of the extraocular muscles.
We treat strabismus in patients who have presented it since childhood (whether they have been treated previously or not), as well as in patients who present it in an acute way due to paralysis, restrictions (severe myopia, thyroid pathology, orbital trauma, tumours), age-related strabismus (sagging eye) and sensory strabismus (secondary to visual deficit).
The main reason for treatment is diplopia (double vision), improving eye mobility or compensatory torticollis and also for aesthetic reasons.
Uveitis is an inflammation of the middle layer of the eye, the uvea, and can affect only the ocular and periocular region or it may be associated with systemic diseases. The aetiology of this clinical picture is very varied and includes trauma, infection, previous eye surgery, systemic inflammatory disease and others.
In this Section, we have access to all the testing required to diagnose and manage these conditions, from exclusively ocular tests, such as wide-field retinography, autofluorescence, optical coherence tomography, campimetry, etc., to extraocular testing in close relation with other specialties across the hospital.
Due to the huge amount of damage that ocular and extraocular tissues can undergo, these conditions are usually treated using powerful anti-inflammatory medicines, such as glucocorticoids. In many cases, inflammation is chronic and therefore requires medicines that allow us to bring it under control effectively and safely in the long term, such as immunosuppressant and biological therapies. These patients must therefore be treated using a multi-disciplinary approach, in collaboration with internal medicine specialists. Our Department benefits from professionals with a huge amount of experience and many years working in this field, who visit patients in appointments within the Department, together with the ophthalmologist.
Sometimes these conditions require surgery, which is performed in the Uveitis Department, whether for aetiological diagnosis (diagnostic vitrectomy, eye tissue biopsy...), or for treatment (cataract surgery, therapeutic vitrectomy...).
The retina sub-specialism is a branch of ophthalmology concerned with studying, diagnosing and treating retina, uvea and vitreous conditions.
Among the pathologies tackled by this sub-specialism are pathologies of the retina that require medical treatment, including: diabetic retinopathy, retinal vascular disorder, such as venous thrombosis or arterial occlusions, age-associated macular degeneration or severe myopia.
The Department has the most advanced technology for the surgical treatment of various retina conditions:
The Department also has the technology required for correct differential diagnosis of tumour pathologies of the eye and to conduct multi-disciplinary exams to diagnose and monitor patients. With regard to treating choroidal melanoma, the Department performs treatment through vitrectomy, acquiring tumour samples, and through tumour endoresection, as well as plaque brachytherapy implant (local radiotherapy).
The Retina Department at Vall d'Hebron Hospital constantly works on implementing and updating protocols of action on the different diseases of the retina and vitreous. The Retina Department is highly committed to research and teaching. It stands out for its long tradition of publications and for publishing chapters in books, as well as for taking part in various national and international studies on the latest scientific advances and technological innovation, allowing us to offer our patients the latest therapeutic advances.
The clinical and basic research activity of the ophthalmology research group focuses on finding new treatments for blindness. We have a research programme in developing new therapeutic strategies based on: a) gene and cell therapies to regenerate or halt the retina degeneration process in pre-clinical models; b) eyewash formulae to discover new anti-inflammatory and anti-oxidant compounds to treat retina conditions; and c) 3D retinal organoids derived from hiPSC and bioscaffolds used as models of retinal disease, both for genome editing and drug screening.
Integrated monitoring of patients with glaucoma, from diagnosis at the GP surgery/hospital to surgical treatment, where required.
Care services are currently conducted
For the past 12 years, the Glaucoma Department has trained resident doctors in the medical and surgical techniques for glaucoma, in weekly sessions divided into three trimesters (1st, 2nd and 4th T). These sessions cover diagnosis and the medical and surgical treatment of the condition. Our aim is to continue this work, as it has had excellent results.
The Glaucoma Department is responsible for annual coordination of and participation in the course. We would like to deliver a yearly course related to the condition glaucoma in which speakers from different hospitals are invited to participate.
Scholarship course for a 4th year resident (R-4) interested in glaucoma as a sub-specialism so that they can take part in the annual European Glaucoma Society (EGS) residents' course.
Residents receive teaching during their rotation in the Glaucoma Unit. It is currently split into two periods of 3 or 4 months. Face-to-face sessions take place with residents on Monday mornings (PSPV). There are also annual refresher courses led by physicians from the Glaucoma Service and physicians external to our hospital.
We are currently involved in several research studies. Scientific activity:
Our Section deals with the diagnosis and treatment of all pathologies affecting the ocular surface, whether inflammatory, infectious, dystrophic, traumatic, tumour-related or degenerative.
Within the Department, we have the most up-to-date complementary tests for diagnosing ocular surface pathologies: specular microscopy, pachymetry, state-of-the-art topography (Pentacam, Cassini), high-resolution anterior segment OCT, etc.
We maintain a close relationship with the departments involved in the diagnosis (Microbiology and Pathological Anatomy) and treatment (Blood and Tissue Bank) of ocular pathologies. This allows us to speed up the diagnostic processes (especially in infectious and tumour processes) and to improve the performance of the treatments applied (amniotic membrane, amniotic membrane extract eye drops, autologous serum eyedrops, cord blood plasma, platelet-rich plasma...)
We have three weekly sub-specialty operating room sessions, which gives us a very short waiting list for ocular surface and keratoplasty techniques. We are a centre especially involved in performing corneal transplants, and in recent years we have remained among the public centres that have performed the most transplants, both in Catalonia and nationally. In the last few years, we have been incorporating lamellar techniques into our transplants (anterior lamellar, DALK type, and posterior endothelial lamellar, DSAEK and DMEK type), so that currently only 30% are penetrating. We thus achieve a lower rate of intraoperative complications, better and earlier sight recovery and a reduction in the incidence of rejection and/or endothelial failure in the medium and long term.
Like the other sections in our Department, we actively participate in training residents in the specialty, as well as in Ophthalmology classes and in placements for fourth-year students of Medicine at the UAB.
As far as research is concerned, the members of the Department conduct work as principal investigators or collaborators in different projects, both in the Ophthalmology Department and in other hospital departments (Oncology). One of these projects allows us to have access to topical treatment of our patients with umbilical cord blood plasma eye drops, which is far superior to other therapeutic options in ocular surface pathologies.
We are a benchmark national unit of expertise (CSUR) for surgical techniques involving complex reconstruction of the ocular surface, especially those using amniotic membrane and temporary or permanent keratoprosthetics.
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.
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