Abstract
Cardiac complications are common, but usually subclinical, after blood and marrow
transplantation. The most frequent causes of serious, life-threatening cardiac complications,
such as severe heart failure, effusive pericarditis, and arrhythmias, are regimen-related
toxicities due to cyclophosphamide and ifosfamide. These are most common in the presence
of pre-existing anthracycline cardiac toxicity. Patients with baseline ejection fractions
less than 50% have a higher incidence of cardiac toxicity. Radiation and other transplant-associated
agents (etoposide, taxol, etc.) are known to have potential, but less frequent, cardiac
toxicities. It may be clinically difficult to distinguish cardiac problems from other
processes, such as pulmonary toxicity, volume overload, or sepsis-related myocardial
depression. Additionally, pericardial, myocardial, and valvular infections are potential,
rare causes of complications and may pose diagnostic challenges. While there is no
consensus regarding the pre-transplant evaluation of left ventricular function, general
guidelines for management issues, both before and after transplant, can be made.
