About 2,000 children a year have surgery in Spain for congenital heart and valve disease: 8 in every 1,000 newborns have some form of defect. The congenital heart disease unit at HM CIEC in Madrid specialises in preserving a child's own valves and was the first in Spain to implant the Melody valve in patients weighing under 5 kg.
How common congenital heart defects are
Congenital heart disease, including valve defects, affects about 8 in every 1,000 newborns. In Spain around 2,000 children a year have surgery for this reason, from newborns to older children whose pacemakers or valve prostheses need replacing as they grow.
A congenital defect is an anatomical change in one of the heart's four chambers, the walls between them or the valves that control blood flow; several abnormalities often occur together. Between 50 and 70 types of defect are known. A valve may be narrowed (stenosis), fail to close fully (regurgitation) or have both problems. Today the diagnosis is usually made before birth or in the first days, weeks or months of life, so treatment decisions can be taken in good time.
The HM CIEC centre in Madrid
The HM CIEC integrated cardiovascular centre is based at HM Montepríncipe University Hospital, part of the HM Hospitales group. Its congenital heart disease unit is led by Dr Fernando Villagra, a paediatric cardiologist and cardiac surgeon with more than 34 years of experience. According to him, the centre performs the largest number of operations for congenital defects among private hospitals in Spain and offers every treatment, both catheter-based and surgical, from the prenatal period to adulthood, with the exception of transplantation.
Preserving the child's own valves
A child grows, and an artificial valve eventually becomes too small and has to be replaced with a larger one. For this reason the unit's surgical programme, headed by Dr Álvaro González Rocafort, focuses on reconstructive techniques that keep a child's own valves working for as long as possible, since they are able to grow with the heart.
The Melody valve
When a valve cannot be preserved, a prosthesis is needed. According to the clinic, HM CIEC was the first in Spain to implant Melody valves in the mitral position in patients weighing up to 5 kg. The advantage of this valve is that it can be sized for diameters below 16 mm and expanded as the child grows, postponing repeat operations.
Pregnancy care for women with congenital heart disease
The centre has a dedicated service for pregnant women with congenital heart disease. Obstetricians, haematologists, paediatric cardiologists and surgeons jointly follow the woman through pregnancy and delivery, assessing mother and baby before and after birth. The service's first patient was a 33-year-old woman with an artificial mitral valve who gave birth to a healthy girl.
When surgery is needed
Some defects close on their own over time and need only monitoring. Most complex defects are treated with surgery or catheter procedures. Each case is discussed at a meeting of all the unit's doctors, who choose the method and decide how urgent it is. The cardiologist then prepares a report, and the surgeon or interventional cardiologist explains the method, the risks and the expected results to the parents or to the patient. Any heart operation carries risks, and no result can be guaranteed.
Psychological support
The unit has a psychologist who supports children and parents during the hospital stay: treatment of a congenital heart defect is a hard and stressful time for the whole family.
Planning treatment for a child in Spain
Send the clinic the medical reports, echocardiography and ECG results and records of earlier procedures; the doctors can assess remotely which method is possible. Check whether the child is fit to fly, how long you need to stay near the hospital after surgery and who will provide follow-up at home. Treatment for adults is covered under cardiology.
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