At our Unit, we use the most advanced technology, so we can offer highly sophisticated examinations and treatments both for the foetus, which becomes a patient before birth, and the mother, who presents very high risk problems, for herself and for the foetus or baby.

Quality, personalised care during gestation requires different highly specialised units that help in possible complications of the mother and the foetus. For mothers, we have an Intensive Care Medicine and Intermediate Obstetric Care Department; for babies, we offer families the most advanced procedures and technology in diagnosis, management and intrauterine neonatal treatments.

Some of the diseases we deal with are:

• Prevention of premature labour with a cervical pessary, a silicone ring that is placed in the cervix and guarantees in almost 100% of cases that the 37 week minimum gestation is respected
• Placental insufficiency and growth restriction
• Maternal infections and how these affect the foetus, malformations, infections, foetal transfusions, complicated and uncomplicated pregnancies with twins.
• We are also pioneers in diagnosis and treatments, such as foetal surgery, especially in cases of foeto-foetal transfusion between monochorionic twins, as well as high risk ultrasounds and prenatal invasive and non-invasive diagnosis.

Research 

The Department set up the Maternal and Foetal Medicine Research Group, recognised by both Catalan and Spanish research agencies, which works at the Vall d'Hebron Research Institute and promotes basic and applied research, and the host laboratories at Vall d'Hebron.

The Maternal and Foetal Medicine Research Group is part of the Division of Obstetrics, Paediatrics and Genetics, and is made up of a network of interdisciplinary researchers in basic and clinical sciences with a shared focus of interest.

Teaching

Our state-level centre enjoys European recognition for the training of EBCOG residents EBCOG (European Board and College of Obstetrics and Gynaecology) and the EAPM (European Association of Perinatal Medicine). We are also the first centre accredited for the training of Fellows2 in gynaecological oncology and breast pathologies by the ESGO (European Society of Gynaecological Oncology).

In our Unit, we treat infants with infections and immunodeficiencies, a pathology that has become increasingly important in recent years. This increase in cases is due to several reasons, such as the emergence of AIDS, the emergence of almost forgotten pathogens, the importing of diseases from other geographical areas, the increase in opportunistic infections as a consequence of more aggressive treatments and more invasive diagnostic techniques, and the presence of new patterns of microbial resistance. This is in addition to the significant differences between treating children and adults. For this reason, our discipline is constantly being reviewed and updated, and is a key specialty for all hospital centres.

Our Unit was created in January 1996, as a hospitalisation unit dedicated to the study and treatment of paediatric illnesses of infectious origin, and in June 2004 it also incorporated the day hospital and the Outpatient Clinic for HIV and Primary Immunodeficiencies. A year later, at the initiative of the centre's management, it consolidated itself as a modern infectology unit, taking over consultation functions in the diagnosis and control of complex infection of critical and immunodepressed patients as well as patients from various paediatric specialties. We went on to incorporate the Outpatient Clinic for Infectious Community Diseases (contracted outside the hospital), Vertical Transmission Infections (from mother to child) and Pathologies, such as tropical diseases.

Portfolio of services

• Infectious pathology consultation service for healthy immunosuppressed children

• Hospitalisation for infectious pathologies and immunodeficiencies

• Genetic counselling and risk assessment for immunodeficiencies

• HIV Outpatient Clinic

• Vertical Transmission Infections Outpatient Clinic

• Community Infectious Diseases Outpatient Clinic

• Primary Immunodeficiencies Outpatient Clinic

• Imported Illnesses Outpatient Clinic

• High resolution clinic

• Second opinion Clinic

• Interhospital Clinic

• Digital Clinic

• “I’m not alone” programme

• Specialised psychosocial care

Teaching

• Undergraduate training at the Autonomous University of Barcelona (UAB)

• Training programme for residents

• Monthly teaching sessions with ten hospital centres, using telemedicine

• Bi-weekly clinical sessions: Tuesday, at 3:00 p.m.; Thursday, at 8:15 a.m.

• Annual continuing education courses: paediatric infectology course and national IFI course

• Master's in paediatric infectology by the UAB.

• Protocols and sessions

Research

The Unit participates in multiple studies and clinical trials, leading many of them. It is also home to the Infections in the immunocompromised paediatric patient research group. The main research lines of the Unit are:

• Safety, efficacy and tolerance of anti-infectious agents

• Family epidemiologic study of primary immunodifficiencies

• Vertical transmission of HIV, Chagas and HTLV

• Evolution of C/N infection by gram-positive cocci and "Candida"

• Hidden hepatitis B virus (HBV) infection in immunocompromised patients

• Hospitalisation risk factors for influenza A (H1N1)

We give nutritional and diet support to hospitalised patients across all clinical departments at the Hospital, and carry out follow-up monitoring at outpatient care for those patients who need it. We also provide outpatient care for patients referred from other healthcare areas of the Hospital and primary care centres that require specialist nutritional and dietary support. Patients requiring nutritional support are treated at the Horta Primary Care Centre. We actively collaborate in educational programmes to detect nutritional problems and for home monitoring of enteral nutrition, that is, feeding via a tube.

As a transversal unit, we support the General, Maternity and Children’s and Traumatology, Rehabilitation and Burns Hospitals, as well as the Primary Care Office in Sant Andreu; we also collaborate with a range of different medical and surgical specialties. We also participate in and direct a number of joint protocols with various other areas of the Hospital, and we maintain a very close working relationship with the Pharmacy Department, both in developing artificial nutrition and in selecting nutritional products. We act together with the Biochemistry Department in monitoring the nutrition of patients and in pursuing lines of research. We also provide support for the Pere Virgili Health Park.

We work to educate patients and family members, as well as providing courses for our staff through our continuing education programme, and we collaborate on continuing education in primary care. We organise training courses for primary care nursing staff, nursing staff from the Hospital and our orderly staff. We also educate patients and relatives about managing enteral nutrition, parenteral nutrition, as well as nutrition in cases of nephrology and inflammatory bowel disease.

Portfolio of services 

During a hospital stay, the nutrition support we provide might cover:

• Diet: adapted and/or personalised diet. In some cases where a conventional diet is not able to meet the needs of patients, nutritional supplements are prescribed.
• Artificial nutrition (enteral or parenteral) according to protocol. Prescription, preparation and monitoring of efficacy and safety of the treatment.

Once a patient has been discharged, we continue to monitor nutritional treatment through:

• Home nutrition programmes (enteral and parenteral)
• Nutritional evaluation and support through consultations
• Daily consultations with a nutritionist
• Preparation of diets after discharge for different diseases

In short, we prepare diets for hospital patients, always taking into account menu alternatives, menus for treatment and diet changes depending on patient cycles. We work together with the Catering Unit to organise and prepare the hospital’s catering operation.

Finally, we also take care of preparing and distributing baby bottles, baby food and special liquid meals for healthcare units, as well as collecting and cleaning utensils.

Teaching

Our teaching work includes:

• Training undergraduate doctors and specialists in endocrinology and nutrition in accordance with the medical residency programme
• Undergraduate training in diet and human nutrition (University of Vic, University of Navarre, University of Barcelona, Blanquerna University, Polytechnic University of Valencia, University of Zaragoza)
• Degree in Dietetics and Human Nutrition (University of Barcelona, Blanquerna University)
• ERASMUS exchange programme for dietitians (Portugal, Mexico, Italy)
• Extended visits for dietitians from abroad (Argentina, Mexico)
• Postgraduate training: Master's degree in nutrition from the Autonomous University of Barcelona (Autonomous University of Barcelona, University of the Balearic Islands, University of Granada)
• Periodic clinical sessions: reviews and clinical cases

At the Gynaecological and Obstetric Emergency Department, we provide care for both gynaecological and obstetric emergencies. To do so, we have a professional team of gynaecology and obstetrics doctors. We also boast a number of anaesthetists, residents, midwives, nurses, assistants and paediatricians. We are open 24 hours a day, 7 days a week.

Our Unit is a pioneer in the treatment of sexual differentiation disorders at the paediatric age. We are also a renowned centre for paediatric renal transplants, and lead the way in Catalonia, especially in complex kidney transplants or transplants in combination with other organs.

Portfolio of services

• Renal biopsies: open and puncture
• Neurogenic bladder: intermittent probes, bladder enlargements (gut, ureter), botulinum toxin injections into the bladder
• Bladder extrophy surgery
• Partial clitoridectomies
• Renal duplicities
• Epispadias
• Upper and lower heminephrectomy
• Percutaneous nephrostomy
• Pyeloplasty (Anderson-Hines technique). Open, laparoscopic and robotic techniques
• Endoscopic puncture of ureterocele
• Vesicoureteral reflux: Cohen technique. Endoscopic submeatal injection
• Continent urinary reservoirs
• Bilateral suprarenalectomy, laparoscopic and robotic techniques
• Hipospadias correction techniques: Mathieu, Snodgrass, Onlai, Duckett, oral or bladder mucous in interscrotals. Meatotomy. Nesbitt technique
• Techniques to resolve urinary incontinence
• Treatment of the megaureter
• Endoscopic treatment of the valves of the posterior urethra
• Surgical treatment of sexual differentiation anomalies
• Kidney transplant
• Kidney transplant from a living donor
• Cutaneous ureterostomies
• Sigmoid vaginoplasty
• Vesicotomies
• Perineal and abdominoperineal vulvovaginoplasty

The Vall d’Hebron Haemodynamics Unit is a centre of excellence with extensive experience in coronary procedures. It has three theatres for operations, one of which is shared with the Arrhythmia Unit. Another one is used for hybrid procedures, with simultaneous participation of specialists in haemodynamics and experts in cardiac surgery. 

The unit has the technology and materials needed to carry out any kind of procedure, such as: 

• rotational angiography 
• optical coherence tomography 
• pressure guides 
• thrombosis capture systems 

The unit is equipped to carry out operations with ventricular assistance and support with extracorporeal membrane oxygenation. It has been working in collaboration with the Pneumology Department for more than 35 years. They combine to treat pulmonary hypertension and to make the assessment before proceeding with lung transplants. The unit is a national benchmark in this field, which is 12% of its total work. It also collaborates with other hospitals internationally. 

The haemodynamics laboratory has advanced anaesthetic and cardiac resuscitation equipment, along with transthoracic, transoesophagal and intracardiac echocardiography. It has specialists working in it for paediatric procedures and for adults with congenital diseases. This guarantees care for patients of any age. 

In 2019, the Haemodynamics Unit carried out: 

• 2,165 diagnostic catheterisations
• 1,360 therapeutic catheterisations. 1,036 of these were angioplasties, of which 304 were angioplasties in the acute phase of a heart attack. 

It was the unit carrying out the most aortic valve implants in Catalonia for the twenty-third consecutive year. Some of these procedures were done using world-leading cutting-edge optimisation techniques. 

Thanks to the collaboration between specialists, more than 190 procedures are carried out on children and more than 80 on adults with congenital heart disease each year. The Cardiology Department takes part in all the structural cardiopathy programmes that need it. It also carries out hybrid procedures in surgery once a month. 

Diseases related to this speciality

Acute myocardial infarction and other acute heart diseases
The majority of the procedures in the Haemodynamics Unit relate to ischaemic heart disease. This occurs when cholesterol plaques build up in the coronary arteries. These take the blood to the myocardium, the heart’s muscle tissue that pumps the blood around the blood stream. When the blood flow in the coronary arteries decreases, an ischaemia or acute myocardial infarction occurs. It usually causes a pain similar to pressure on the chest, known as chest angina. When the coronary artery is completely obstructed, an acute myocardial infarction occurs which causes heart cells to die. It is a serious illness and requires the artery to be opened immediately. This is usually done with a catheterisation. The patient is subsequently admitted to the Cardiology Critical Care Unit. 

The Cardiology Department Haemodynamics Unit at Vall d’Hebron treats infarctions with catheterisation 24 hours a day, 365 days a year. It is one of the benchmark hospitals providing continuous care for this illness in Catalonia. 

Heart valve disease
The majority of heart valve diseases can only be treated with cardiac surgery. When the disease is degenerative, due to age and ageing, techniques such as an aortic valve implant or a MitraClip can also be used. To decide on suitable treatment, the “heart team” intervene. This is a multi-disciplinary team, consisting of clinical, surgical, cardiology, imaging and anaesthesia experts and specialists in critical cardiac care. 

Paediatric and adult congenital heart disease
The most frequent heart disease is congenital. Techniques to treat congenital defects via the skin often supplement reconstructive surgery. Vall d’Hebron is a worldwide benchmark for this operation on people of all ages. Paediatric treatments have been developed to adapt to children’s growth and evolution. 

Pulmonary hypertension/lung transplant
Increase in pressure in the pulmonary arteries may be a secondary disorder to other cardiac or pulmonary disease, or also may be a primary problem. The treatment for this disease requires monitoring to control the pressure’s reaction to the drugs. The patient can be monitored using right heart catheterisation and using the vascular/pulmonary remodelling study with intravascular ultrasound. Patients having a lung transplant must undergo a series of cardiac tests beforehand, to ensure the success of the operation. The tests are catheterisation and coronary revascularisation. Catheterisations are also done in a situation of isometric and dynamic physical exercise to assess the heart’s response to the effort. 

Treatments and diagnostic tests related to this speciality

The Haemodynamics Unit carries out interventional diagnostic and interventional therapeutic catheterisations.

Interventional diagnostic catheterisations 

The most usual is the study of the heart’s anatomy using a coronary catheterisation. The procedure consists of inserting a catheter into an artery in the forearm or leg until it reaches the coronary artery. The catheter allows the radiocontrast agent to be introduced in order to visualise the artery using radioscopy. Specific material may also be inserted to unblock the artery.

Other diagnostic procedures using a catheter are as follows:

• Haemodynamic and angiocardiogram diagnostics for congenital or acquired heart disease that cannot be diagnosed with other cardiac or cardiovascular explorations
• Pulmonary arterial hypertension study
• Cardiac study prior to a lung transplant
• Endomyocardial biopsy

Interventional therapeutic catheterisations

These are procedures via the skin that enable the treatment of some heart diseases and lesions without surgery.

The most common is coronary angioplasty. This consists of unblocking the coronary artery using a catheter. This is often done in the acute phase of a myocardial infarction, along with suction of the thrombosis that obstructed the artery and caused the infarction. The catheter is also used to insert a stent, a small cylindrical mesh, to completely open the coronary artery at the obstruction point. 

The unit carries out other procedures, such as: 

• Aortic valve implants. This treatment consists of inserting an artificial valve made of biological material via a catheter, to replace the ailing aortic valve. 
• Repair of the mitral valve in cases of insufficiency. A small device is inserted to suture the defective mitral valve and reduce insufficiency. 
• Repair of congenital cardiac defects, such as atrial septal defect or patent ductus arteriosus. There is a particular repair device for each defect. It is inserted using a catheter.
• Pulmonary artery dilations, whether due to congenital narrowing or chronic pulmonary thromboembolisms caused by pulmonary hypertension.

Research

The Haemodynamics Unit takes active part in lines of research, for example:

• Myocardial damage, with the aim of using the knowledge for the benefit of the patients.
• The modification of stents, extendible meshes to open arteries, and the arteriosclerosis plaque with a coronary laser 
• The clinical result of closing mitral periprosthetic leaks 
• Early endothelialisation in coronary stents 
• Special coronary stents for bifurcations 
• The repercussion of pulmonary hypertension on the pulmonary arterial wall

Education

The Haemodynamics Unit's team of professionals takes 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 from other Spanish, European and Latin American hospitals who are interested in training on this sub-speciality. The unit's professional team regularly takes part in training activities outside the hospital.

Each year, the unit organises a guidance course on treating coronary bifurcations with imaging techniques. It also organises a course on choosing a catheter, as a guide for coronary angioplasty. A course in the form of practical academia on the treatment of chronic occlusions is held twice a year.

Experts

The Haemodynamics Unit has a section head and six assistants. They work with the nursing team, which consists of thirteen specialist professionals. The latter work in the theatres and in the hybrid operating theatre, as and when needed.

Our Department is one of the finest in the country, especially for oncology, for cancer of the breast and lower female genitalia. These are complex pathologies whose treatment must take a multidisciplinary approach. Thanks to the support we receive from multiple specialists, we are proud to offer a high-quality service.

Coordinating with primary care services and providing comprehensive care from the very first point of contact are both essential aspects of the service. This is necessary for women of all ages, from paediatric gynaecology, paediatric endocrinology, gynaecological pathologies, pre-invasive lesions, which can be precursors to cancer, and malignant tumours in both the genitalia and the breast, menopause and post-menopausal pathologies.

Our overall objective is to provide care for patients in our area of influence, including gynaecological care, as well as training and healthcare prevention measures and, at the same time, we aim to become a Centre of Excellence for certain pathologies, such as high-complexity surgeries.

The specific objectives of the healthcare division are, firstly, to provide medical care as urgently as possible in presumably benign pathologies. For all patients with either presumptive or confirmed diagnosis of neoplasia (abnormal formation of a new tissue, benign or malignant tumour), both gynaecological and mammary, immediate care must be provided. Finally, we must review and produce protocols and clinical guides for all the most common pathologies.

In all cases, we aim to carry out surgical treatment of gynaecological and mammary neoplasms when indicated with as short a waiting time as possible between diagnosis, histology and surgery.

Portfolio of services

• General Gynaecology and Pelvic Floor Unit
• Gynaecological Oncology and Lower Genital Tract Pathology Unit
• Endoscopic Surgery Unit
• Breast Centre
• Breast Pathology Unit
• Gynaecological Ultrasound Unit

This Unit was created in 1968, in the first years of the Hospital, by Dr Enric Vicens-Calvet, and since then we have offered paediatric endocrinology as a specialty, actively participating in the constitution of the Spanish Society of Paediatric Endocrinology and the International Association for Child and Adolescent Diabetes. (IESGD). It is made up of:

• Paediatric General Endocrinology Clinic (daily)
• Monographic Diabetes Clinic
• Diabetes Education
• Monographic Adolescent Morbid Obesity Clinic
• Monographic Sexual Differentiation Disorders Clinic
• Clinic for the Neonatal Screening Programme for Congenital Hypothyroidism
• Functional Endocrinological Explorations Unit

Portfolio of services 

• Care for diabetic children and comprehensive diabetes education
• Diagnosis and monitoring of congenital hypothyroidism in Catalonia
• Diagnosis and monitoring of thyroid function in premature babies (collaboration with the Neonatology Department)
• Diagnosis, treatment and monitoring of thyroid pathologies in children and adolescents
• Diagnosis, treatment and monitoring of sexual differentiation disorders
• Diagnosis, treatment and monitoring of disorders affecting puberty
• Comprehensive programme for obesity in infants and children (Children and Teens in Movement programme)
• Morbid obesity programme for teenagers (in collaboration with the Paediatric Surgery Department and the Metabolic Surgery Unit)
• Endocrinological controls on patients affected by cancer
• Diagnosis and treatment of patients affected by phosphocalcic metabolism disorders
• Diagnosis and treatment of patients with lipid disorders
• Diagnosis and monitoring of patients with growth disorders

Research

The Paediatric Endocrinology Unit carries out significant research activity, and has a laboratory for research into growth pathologies and sexual differentiation disorders. We are also pioneers in the design and implementation of public health programmes aimed at the prevention of childhood and youth obesity (Children in Movement Programme), the treatment of morbid obesity in teens, and we are also a reference hospital in the diagnosis and treatment of congenital hypothyroidism.

Teaching 

Our Unit is also dedicated to teaching, and for more than 18 years, we have offered a master’s programme in paediatric endocrinology and nutrition, a postgraduate programme that has resulted in more than 180 qualified paediatricians receiving training in paediatric endocrinology. They are now heads of paediatric endocrinology units at the majority of level two and three hospitals with a Paediatrics Department in Catalonia, the rest of Spain and Latin America. All the Unit’s medical staff participate actively both in undergraduate and postgraduate education.