J Angel

Hospital Valle Del Nalon, Rianxo, Galicia, Spain

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Publications (47)157.02 Total impact

  • Value in Health 11/2011; 14(7). DOI:10.1016/j.jval.2011.08.098 · 2.89 Impact Factor
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    ABSTRACT: To evaluate the feasibility and safety of the Nile Croco® coronary bifurcation stent system (Minvasys, Gennevilliers, France). The primary endpoint was to assess the acute device success and angiographic success with the use of the Nile Croco® stent system. Secondary endpoints included in-hospital and six month major cardiac events (MACE).There were 151 consecutive patients enrolled in the Nile Croco Study at Vall Hebrón Hospital. The Nile Croco® stent was successfully implanted in 144 patients (95.4%) and final angiographic success was obtained in 100% of the patients. 138 out of the 151 (91%) patients included have accomplished the six month follow-up. There was one in-hospital MACE in the 151 recruited patients. The MACE rate at six months in the 138 patients with follow-up was 14% and the ischaemia-driven TLR rate was 7.2 %. The results of our Nile Croco® Study are the first to demonstrate the safety and high performance of this dedicated stent system for the treatment of bifurcation lesions. The device can be successfully implanted in more than 95% of all cases, with a high procedural success rate and low in-hospital and six month MACE rates.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 06/2011; 7(2):216-24. DOI:10.4244/EIJV7I2A36 · 3.76 Impact Factor
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    ABSTRACT: Histological composition of material obtained by thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (STEMI) is highly variable. We aimed to characterize this material using magnetic resonance imaging (MRI) and to correlate MRI findings with the success of PCI in terms of ST-segment resolution. Thrombus aspiration during primary or rescue PCI was attempted in 100 consecutive STEMI patients, of whom enough material for MRI was obtained in 59. MR images were obtained at 9.4T and T1 and T2 values were measured. Patients with (n = 31) and without (n = 28) adequate ST resolution 120 min after PCI (≥70% of pre-PCI value) had similar baseline characteristics except for a higher prevalence of diabetes mellitus in the latter (10 vs. 43%, p = 0.003). T1 values were similar in both groups (1248±112 vs. 1307±85 ms, respectively, p = 0.7). T2 values averaged 31.2±10.3 and 36.6±12.2 ms; in thrombus from patients with and without adequate ST resolution (p = 0.09). After adjusting for diabetes and other baseline characteristics, lower T2 values were significantly associated with inadequate ST resolution (odds ratio for 1 ms increase 1.08, CI 95% 1.01-1.16, p = 0.027). Histology classified thrombus in 3 groups: coagulated blood (n = 38), fibrin rich (n = 9) and lipid-rich (n = 3). Thrombi composed mostly of coagulated blood were characterized as being of short (n = 10), intermediate (n = 15) or long evolution (n = 13), T2 values being 34.0±13.2, 31.9±8.3 and 31.5±7.9 ms respectively (p = NS). In this subgroup, T2 was significantly higher in specimens from patients with inadequate perfusion (35.9±10.3 versus 28.6±6.7 ms, p = 0.02). This can be of clinical interest as it provides information on the probability of adequate ST resolution, a surrogate for effective myocardial reperfusion.
    PLoS ONE 04/2011; 6(4):e18459. DOI:10.1371/journal.pone.0018459 · 3.53 Impact Factor
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    Circulation 03/2010; 121(10):1176-87.. · 14.95 Impact Factor
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    ABSTRACT: To identify the therapeutic regimens used at discharge in patients receiving oral anticoagulant therapy (OAT) who undergo stenting percutaneous coronary intervention and stent implantation (PCI-S), and to assess the safety and efficacy associated with different therapeutic regimens according to thromboembolic risk. A prospective multicentre registry. In hospital, after discharge and follow-up by telephone call. 405 patients (328 male/77 female; mean (SD) age 71 (9) years) receiving OAT who underwent PCI-S between November 2003 and June 2006 from nine catheterisation laboratories of tertiary care teaching hospitals in Spain and one in the United Kingdom were included. Three therapeutic regimens were identified at discharge: triple therapy (TT) -- that is, any anticoagulant (AC) plus double antiplatelet therapy (DAT; 278 patients (68.6%); AC and a single antiplatelet (AC+AT; 46 (11.4%)) and DAT only (81 (20%)). At 6 months, patients receiving TT showed the greatest rate of bleeding events. No patients receiving DAT at low thromboembolic risk presented a bleeding event (14.8% receiving TT, 11.8% receiving AC+AT and 0% receiving DAT, p = 0.033) or cardiovascular event (6.7% receiving TT, 0% receiving AC+AT and 0% receiving DAT, p = 0.126). The combination of AC+AT showed the worst rate of adverse events in the whole cohort, especially in patients at moderate-high thromboembolic risk. In patients receiving OAT, TT was the most commonly used regimen after PCI-S. DAT was associated with the lowest rate of bleeding events and a similar efficacy to TT in patients at low thromboembolic risk. TT should probably be restricted to patients at moderate-high thromboembolic risk.
    Heart (British Cardiac Society) 06/2009; 95(18):1483-8. DOI:10.1136/hrt.2009.167064 · 6.02 Impact Factor
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    ABSTRACT: Patients with exercise angina >2 months (n:13) showed significantly lower SigmaST elevation during 120 s balloon coronary occlusion than those with =<2 months (n:7), or those with angina at rest <=2 days (n:8) but similar to patients with angina at rest >2 days (n:7). These results underscore the importance of the kind and duration of angina in limiting the extent of ischemia during coronary occlusion.
    International journal of cardiology 08/2008; 127(3):433-5. DOI:10.1016/j.ijcard.2007.04.133 · 6.18 Impact Factor
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    ABSTRACT: A true bifurcated lesion in coronary atherosclerotic disease is present in approximately 15% of patients referred for percutaneous coronary intervention (PCI). 1 The percutaneous approach to this especially complex scenario has been faced in many different ways depending on the techniques available at any particular time. 2–4 In the last few years, the introduction of drug-eluting stents (DES) has remarkably improved the outcome in bifurcation lesions compared with using bare-metal stents (BMS), resulting in fewer adverse events and lower main branch (MB) restenosis rates. 5–7 However, the most suitable approach to the side branch (SB) remains uncertain. Although the initial 'provisional' stenting technique (i.e. stenting of the SB after MB stenting only in cases of suboptimal or inadequate result) is probably the prevailing approach, the four stent techniques that allow the stenting of both branches (i.e. crush, V, T, culottes) are appealing. However, even if the strategy of stenting both branches when the SB stenosis is suitable for stenting is promising, data in the literature indicate that clinical outcomes are better if routine usage of the two-stent strategy is avoided. 8 The introduction of dedicated stents may be supposed to be an attractive strategy for approaching the different types of bifurcation lesion. These stents are specifically designed to provide good deliverability, secured access to the SB and complete coverage of the lesion site without double/triple layers of stent struts. They also incorporate the benefits of drug elution and ensure drug availability to all diseased surfaces. The objective of the observational multicentre Nile Croco Registry was to assess the angiographic and six-month clinical results of a cohort of patients with bifurcation lesions who underwent PCI with dedicated stents. • presumed new bifurcation lesion in a main vessel with a reference diameter ≥2.5mm (visually assessed); and • an SB diameter ≥2.0mm. Patients with two-or three-vessel disease were included if the other vessel lesions could presumably be successfully treated by PCI or were not tributary for either PCI or coronary bypass graft (CABG). In addition, patients with other lesions in the same vessel were included if these were proximal to the bifurcation lesion. The major exclusion criteria were: • presence of non-cardiac severe pathology or life expectancy of less than six months; • bifurcation lesion type 0,0,1 according to the Medina Classification 9 (type 4b according to Massy class); • presence of thrombus in the target lesion; • severely tortuous coronary vessel; • calcifications proximal to the target lesion; and • left main coronary lesion or left anterior descending artery (LAD) lesion involving the ostia. Study Device The Nile Croco ® intracoronary stent system consists of an 18mm balloon-expandable chromium–cobalt BMS pre-mounted on a dedicated delivery system with two independent balloons, each with a rapid-exchange lumen for the two guidewires required. The MB balloon is available in diameters of 2.5, 3.0 and 3.5mm, and the SB balloon in diameters of 2.0, 2.5 and 3.0mm. There are five devices available using different combinations: MB 2.5 SB 2.0, MB 3.0 SB 2.0, MB 3.0 SB 2.5, MB 3.5 SB 2.5 and MB 3.5 SB 3.0. The Nile Croco intracoronary stent is compatible with 6F guiding catheters (inner diameter ≥0.70 inches), and consists of a dedicated MB stent proximally crimped over the tip of the SB catheter. The stent consists of three segments: the distal segment includes six to eight cells (depending on the size), the medial segment includes eight to 10 cells and the proximal segment includes seven to nine cells. This design ensures the same metal–artery ratio along the bifurcation and avoids cell overstretching, bearing in mind that the morphology of the artery at the bifurcation sites is not cylindrical and thus should accommodate the SB portal once implanted. The delivery system is based on two separate rapid-exchange balloons: one for stent deployment in the MB and the other for opening the stent strut towards the SB. It allows final kissing-balloon inflation and a strategy of MB stenting with provisional SB stenting. The design incorporates an auto-release sheath that wraps both catheter shafts to avoid distal dislodgement of the tip of the Bruno Garcia del Blanco is a Consultant in the Department of Interventional Cardiology at the Hospital Vall d'Hebrón in Barcelona, a position he has held since 2005. He is a member of numerous professional societies, including the Spanish Society of Cardiology and the European Society of Cardiology (ESC). His core research areas include the development of devices for coronary percutaneous approaches and myocardial protection during reperfusion.
    01/2008; 3(1). DOI:10.15420/icr.2008.3.1.46
  • Revista Española de Cardiología Suplementos 01/2007; 7(8). DOI:10.1016/S1131-3587(07)75272-X
  • Journal of Nuclear Cardiology 03/2005; 12(2). DOI:10.1016/j.nuclcard.2004.12.090 · 2.65 Impact Factor
  • Journal of Nuclear Cardiology 02/2005; 12(2):S16-S17. · 2.65 Impact Factor
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    ABSTRACT: Clinical decisions regarding diagnosis and effective treatment of coronary artery disease frequently require integration of information from various imaging modalities, which are acquired, processed, and read at different physical locations and times. We have developed methods to integrate the information in 2 cardiac imaging studies, perfusion SPECT and coronary angiography. Three-dimensional (3D) models of the coronary artery tree created from biplane angiograms were automatically aligned with 3D models of the left ventricular epicardial surface created from perfusion SPECT. Myocardial mass at risk was used as a unique measure to validate the accuracy of the unification. Thirty patients were injected with the perfusion agent (99m)Tc-tetrosfosmin during balloon occlusion while undergoing percutaneous transluminal coronary angioplasty for single-vessel coronary artery disease. Thus, a single, severe perfusion defect was induced by a single coronary artery occlusion of known severity and placement. The accuracy of the unification was measured by computing the overlap between physiologic area at risk, determined using SPECT perfusion quantification techniques only, and anatomic area at risk, determined using coronary artery anatomy aligned with the epicardial surface of the left ventricle. The unification resulted in an 80% overlap of areas at risk, and an overlap of 84% of normal areas, for all coronary artery distributions. The mass at risk measured based on the unified anatomic information correlated with the physiologically based mass at risk as y = 0.92x + 10.3 g; r = 0.76, SEE = 10.4 g. A unification algorithm for automatically registering 3D models of the epicardial surface from perfusion SPECT and 3D coronary artery trees from coronary angiography has been presented and validated in 30 patient studies.
    Journal of Nuclear Medicine 06/2004; 45(5):745-53. · 5.56 Impact Factor
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    ABSTRACT: To assess the structural and functional characteristics of pulmonary arteries by intravascular ultrasound (IVUS) in the setting of primary pulmonary hypertension, and to correlate the ultrasound findings with haemodynamic variables and mortality at follow up. Prospective observational study. University hospital (tertiary referral centre). 20 consecutive patients with primary pulmonary hypertension (16 female; mean (SD) age, 39 (14) years). Cardiac catheterisation and simultaneous IVUS of pulmonary artery branches at baseline and after infusion of epoprostenol. 33 pulmonary arteries with a mean diameter of 3.91 (0.80) mm were imaged, and wall thickening was observed in all cases, 64% being eccentric. Mean wall thickness was 0.37 (0.13) mm, percentage wall area 31.0 (9.3)%, pulsatility 14.6 (4.8)%, and pulmonary/elastic strain index 449 (174) mm Hg. No correlation was observed between IVUS findings and haemodynamic variables. Epoprostenol infusion increased pulsatility by 53% and decreased the pulmonary/elastic strain index by 41% (p = 0.0001), irrespective of haemodynamic changes. At 18 (12) months follow up, nine patients had died. A reduced pulsatility and an increased pulmonary/elastic strain index were associated with increased mortality at follow up (12.0 (4.4)% v 16.4 (4.4)%, p = 0.03; 369 (67) v 546 (216) mm Hg, p = 0.02). IVUS demonstrated pulmonary artery wall abnormalities in all patients with primary pulmonary hypertension, mostly eccentric. The severity of the changes did not correlate with haemodynamic variables, and epoprostenol improved pulmonary vessel stiffness. There was an association between impaired pulmonary artery functional state as determined by IVUS and mortality at follow up.
    Heart (British Cardiac Society) 04/2003; 89(3):311-5. DOI:10.1136/heart.89.3.311 · 6.02 Impact Factor
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    ABSTRACT: In everyday clinical practice, the cardiologist needs to integrate anatomical and functional information from patients with coronary artery disease. The aim of this study is to present a way to unify, in three-dimensional images, anatomical information from coronary angiography with physiological information from myocardial perfusion scintigraphy. Three patients with one vessel disease (left anterior descending, right coronary and left circumflex arteries, respectively) scheduled for percutaneous coronary revascularization were selected. Two-dimensional angiographic images were obtained before and after revascularization. 99mTc-tetrofosmin was administered during coronary occlusion and tomographic images corresponding to the occlusion were detected after coronary dilatation. Control rest scintigraphic images were obtained after two days. The three-dimensional coronary tree from coronary angiography was superposed on the epicardial contours of the myocardial perfusion images following a method of our own. A correct three-dimensional reconstruction of myocardial contour and coronary tree was achieved for each patient. The three-dimensional unified images showed excellent concordance between the extent of perfusion defects and the anatomic distribution of the occluded vessel. Three-dimensional unification of myocardial perfusion images and coronary angiography is technically possible. This technology integrates anatomical and functional information to facilitate the cardiologist's decision-making and so improve coronary patient management.
    Revista Espa de Cardiologia 04/2002; 55(3):258-65. · 3.34 Impact Factor
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    ABSTRACT: Introduction and objetives In everyday clinical practice, the cardiologist needs to integrate anatomical and functional information from patients with coronary artery disease. The aim of this study is to present a way to unify, in three-dimensional images, anatomical information from coronary angiography with physiological information from myocardial perfusion scintigraphy. Methods Three patients with one–vessel disease (left anterior descending, right coronary and left circumflex arteries, respectively) scheduled for percutaneous coronary revascularization were selected. Two-dimensional angiographic images were obtained before and after revascularization. 99mTc-tetrofosmin was administered during coronary occlusion and tomographic images corresponding to the occlusion were detected after coronary dilatation. Control rest scintigraphic images were obtained after two days. The three-dimensional coronary tree from coronary angiography was superposed on the epicardial contours of the myocardial perfusion images following a method of our own. Results A correct three-dimensional reconstruction of myocardial contour and coronary tree was achieved for each patient. The three-dimensional unified images showed excellent concordance between the extent of perfusion defects and the anatomic distribution of the occluded vessel. Conclusions Three-dimensional unification of myocardial perfusion images and coronary angiography is technically possible. This technology integrates anatomical and functional information to facilitate the cardiologist's decision- making and so improve coronary patient management.
    Revista Espa de Cardiologia 01/2002; 55(3):258–265. DOI:10.1016/S0300-8932(02)76594-9 · 3.34 Impact Factor
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    ABSTRACT: A high number (30%-50%) of reversible defects have been detected early after coronary balloon angioplasty. Inadequate luminal enlargement despite a good angiographic appearance has been suggested as a possible mechanism of these perfusion abnormalities, and some reports have shown better coronary flow reserve after coronary stent implantation than after balloon dilatation. The primary objective of this study was to evaluate the frequency of early ischemic defects detected by maximal exercise (plus dipyridamole) with (99m)Tc-tetrofosmin SPECT after successful coronary angioplasty with stent implantation. A secondary objective was to determine the prognostic value of these early ischemic defects. Thirty patients without previous myocardial infarction who successfully underwent 1-vessel coronary angioplasty with stent implantation were studied. Maximal-exercise (99m)Tc-tetrofosmin myocardial SPECT, with simultaneous dipyridamole if exercise was suboptimal, was performed at 6 +/- 1 d (mean +/- SD) after percutaneous transluminal coronary angioplasty. At 8 +/- 3 mo, all patients were followed up clinically, and 77% of them underwent follow-up angiography. The percentage of stenosis decreased from 68.5% +/- 12.6% of luminal diameter to 9.3% +/- 8.8% after stent implantation, and minimal luminal diameter increased from 0.89 +/- 0.36 mm to 2.85 +/- 0.45 mm. Mild-to-moderate reversible myocardial defects in the territory of the dilated artery were detected in 5 patients (17%), with no angiographic or procedural differences occurring between them and patients without ischemic defects. At follow-up, the target lesion revascularization rates depending on the presence or absence of early ischemic defects were 40% and 8%, respectively (P = 0.18). Angiographic restenosis occurred in 3 of 4 patients who had early ischemic defects and underwent follow-up angiography and in 3 of 19 patients who had no early ischemic defects and underwent follow-up angiography (restenosis rate, 75% and 16%, respectively; P < 0.05). Coronary angioplasty with stent implantation is associated with a 17% rate of ischemic defects early after the procedure. Patients with early myocardial perfusion defects after coronary stent implantation had a high rate of restenosis.
    Journal of Nuclear Medicine 12/2001; 42(12):1768-72. · 5.56 Impact Factor
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    ABSTRACT: Although different Doppler methods have been validated for aortic regurgitation quantification, the benefit of combining information from different methods has not been defined. Our study included 2 phases. In the initial phase (60 patients), Doppler parameters (jet width, short-axis jet area, apical jet area, regurgitant fraction from pulmonary and mitral flow, and deceleration slope) were correlated with angiography; range values for each severity grade were defined and intraobserver and interobserver and intermachine variability were studied. In the validation phase (158 patients), defined value ranges were prospectively tested and a strategy based on considering as the definitive severity grade that in which the two best methods agreed was tested. Jet width had the best correlation with angiography (r = 0.91), and its ratio with the left ventricular outflow diameter did not improve the correlation (r = 0.85) and decreased reproducibility. Apical jet area and regurgitant fraction from pulmonary flow permitted acceptable quantification (r = 0.87 and 0.86, respectively) but with worse reproducibility. The other methods were not assessable in 20% to 30% of studies. Concordance with angiography decreased in jet width when the jet was eccentric (90% vs 77%, P <.01), in apical jet area when mitral valve disease was present (84% vs 65%, P <.02), and in short-axis jet area and regurgitant fraction from pulmonary flow with concomitant aortic stenosis (77% vs 44%, P <.002 and 77% vs 53%, P <.02, respectively). Agreement with angiography was very high (94 [95%] of 99) when severity grade coincided in both jet width and apical jet area. In 59 cases without concordance, regurgitant fraction from pulmonary flow was used as a third method. Overall, this strategy permitted concordance with angiography in 146 patients (92%). Jet width is the best predictor in aortic regurgitation quantification by Doppler echocardiography. However, better results were obtained when a strategy based on concordance between jet width and another Doppler method was established, particularly when the jet was eccentric.
    American Heart Journal 06/2000; 139(5):773-81. DOI:10.1067/mhj.2000.104503 · 4.56 Impact Factor
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    ABSTRACT: We report a patient with refractory angina in the postoperative period of a coronary artery bypass grafting. Ischemia was due to a large side branch of the left internal mammary artery causing steal phenomenon that was treated with transcatheter coil embolization.
    Revista Espa de Cardiologia 12/1998; 51(11):915-7. · 3.34 Impact Factor
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    ABSTRACT: To analyze the efficacy of single photon emission tomography (SPET) with 99mTc-compounds for the diagnosis of restenosis of previous percutaneous transluminal coronary angioplasty (PTCA). Seventy-one patients (16 women, median age: 60 years, 35 with multivessel disease, 78 arteries with PTCA) with previous PTCA and with coronary angiography performed after scintigraphy were studied. 99mTc-SPET exercise (53 with MIBI and 18 with tetrofosmin) was performed, for clinical reasons, to all patients between one month and 4 years after PTCA. Intravenous dipyridamole was administered simultaneously to 16 patients who had insufficient exercise. SPET sensitivity, specificity, positive predictive values, negative predictive values and global values were all significantly higher than those obtained with exercise tests (80% vs 63%; p = 0.05; 83% vs 37%; p = 0.001; 91% vs 69%; p = 0.007; 64% vs 31%; p = 0.009, and 81% vs 55%; p = 0.0006, respectively). These results were significantly superior in patients with one vessel disease than in patients with multivessel disease. SPET exercise with 99mTc-compounds is a test with a high efficacy for the diagnosis of post-PTCA restenosis, mainly in patients with one vessel disease.
    Revista Espa de Cardiologia 09/1998; 51(8):648-54. · 3.34 Impact Factor
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    ABSTRACT: Determination of pulmonary to systemic blood flow ratio (QP/QS) is considered to be important for the management of patients with atrial septal defect. The QP/QS provides information on shunt severity and is usually determined by three methods: oximetry, first-pass radionuclide angiocardiography and Doppler echocardiography. The aim of the present study was to assess the accuracy and concordance level of these three methods in QP/QS quantification in atrial septal defects. Sixty-four adult atrial septal defects patients in whom QP/QS was determined by these three methods with a 6 month interval were studied. Nuclear and echocardiographic post-surgical studies were repeated in 36 patients. QP/QS values determined by the three techniques had a low correlation between them: oximetry (r = 0.52; SEE = 0.74); radionuclide angiocardiography (r = 0.40; SEE = 0.79) and Doppler echocardiography (r = 0.72; SEE = 0.57). Radionuclide angiocardiography underestimated QP/QS > 3 (-0.61 +/- 1.21; p < 0.01). Only in 33% of studies there concordance (differences < 0.5) among the three methods and in 58% between two methods. Right ventricular dilatation and tricuspid regurgitation influenced radionuclide accuracy. Nevertheless, the correlation between this technique and echocardiography was satisfactory when the 36 post-surgical were included (r = 0.75); both techniques agreed in the diagnosis of the two cases with residual post-surgical shunt. Inter-method disparity in QP/QS quantification is high and no method can be used as a gold standard; clinical decisions therefore based on QP/QS quantification by one technique alone are ill-advised.
    Revista Espa de Cardiologia 01/1998; 51 Suppl 1:2-9. · 3.34 Impact Factor

Publication Stats

190 Citations
157.02 Total Impact Points

Institutions

  • 2011
    • Hospital Valle Del Nalon
      Rianxo, Galicia, Spain
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
  • 2009
    • Hebron University
      Al Khalīl, West Bank, Palestinian Territory
  • 1988–2008
    • University Hospital Vall d'Hebron
      • Department of Cardiology
      Barcino, Catalonia, Spain
  • 2005
    • Vall d’Hebron Institute of Oncology
      Barcino, Catalonia, Spain