Pericardial fluid collections are common postoperatively in all cardiac surgical procedures. The pericardium is left open after heart transplantation, but localized collections of fluid can accumulate, causing myocardial compression and subsequently limiting left ventricular filling. The triad of elevation of central venous pressures, low systemic blood pressure, and low cardiac output merits evaluation with transesophageal echocardiography to distinguish cardiac tamponade from right ventricular failure (Table 3.). Often, diastolic equalization of pressures is not present.
Table 3 Differential diagnoses of low blood pressure, low cardiac output, and high central venous pressure following heart transplantation
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