Paediatrics

We have a prenatal diagnosis programme for both national and international patients; international patients are consulted through telemedicine. We have a Mother and Child Service with Obstetrics and Neonatology that is highly specialised in treating heart defects. All types of neonatal heart defects are treated, including those in premature and underweight babies. Extracorporeal circulation techniques are used, which are dedicated to maintaining organ perfusion, which guarantees low morbidity rates. A 7-day stay and approx. 96% survival rate.

• Hypoplastic left heart syndrome.
• Total anomalous pulmonary venous drainage.
• Hypoplastic aortic arch.
• Interrupted aortic arch.
• Truncus arteriosus.
• Pulmonary atresia.

Pulmonary atresia with ventricular septal defect (VSD) is a rare congenital heart defect. Highly complex and with a group 4 ABS, the main aim is to establish a single source of pulmonary blood flow, unifocalising the collaterals, closing the VSD and implanting a valved conduit between the RV and PA.

We are international experts, performing the 3 main types of procedure: 1) unifocalisation in the first year of life, 2) staged repair of PA, 3) repair of PA using hybrid procedures (Interventional Haemodynamics), depending on the anatomic type.

At the end of treatment, 90% of patients have VSD closure and a survival rate 96%. These results make us stand out at an international level.

Tetralogy of Fallot is a complex congenital heart defect that takes many forms and can be treated from neonatal age to adulthood.

The main aims are to establish sufficient pulmonary flow, VSD closure, and pulmonary valve preservation, using hybrid techniques of interventional catheterisation during surgery, which enables the dilation of the pulmonary valve annulus with a balloon, avoiding cutting it and enabling the preservation of the pulmonary valve, thus preventing the need of further operations in adulthood. In 95% of cases, we preserve the pulmonary annulus with a z score of -3.

It is the most common heart defect that requires surgical treatment at neonatal age.

Our centre performs an arterial switch in all patients with TGA regardless of their coronary pattern.

Complex TGA:

• TGA with VSD
• TGA with hypoplastic aortic arch and/or coarctation of the aorta (CoA) and
• TGA with pulmonary stenosis (PS)

We perform all kinds of techniques to anatomically correct this defect, including the Rastelli and Nikaidoh procedures for TGA, VSD and PS.

This is one of the challenges of the speciality, since suitably sized valve prostheses for small patients do not exist. At our centre, we are very experienced in performing aortic valvuloplasty for aortic stenosis in neonatal age. Different aortic and mitral valve reconstruction techniques are used in patients under one year old, with valve preservation with an average of 10 years without the need to re-operate.

The surgical team is one of the most experienced and has the best results at European level in the Ross and Ross-Kono procedures, including in infant and neonatal age patients.

Highly complex heart defects, where there is only one functional ventricle, and after various surgical treatments, patients end up having the Fontan circulation procedure. The surgical team was one of the pioneers in using the extra-cardiac Fontan procedure in Europe (C. Marcelletti procedure), gathering one the largest case studies. In cardiac malpositions, reconstruction of the tunnel with an intra/extra-cardiac conduit is used with very good results. This technique is performed in very few centres at present.

We have a highly specialised team of interventional haemodynamics specialists who, together with the surgical team, deal with all tributary conditions with this type of treatment. E.g. Apical VSD, stent insertion, pulmonary valve implants, among others.