[Special anesthesia care in heart transplantation. The management of right ventricular failure]

Right ventricular dysfunction is a common clinical event after heart transplantation. The major cause is the failure of right ventricle (RV) to adapt to the pulmonary hypertension (PH) secondary to chronic heart failure. Nevertheless, this dysfunction is usually transient owing to the reversibility of PH, the nature of which is mainly passive. Therefore, it is particularly important to perform a preoperative hemodynamic study to identify those cases in which PH is a permanent component, a situation that excessively increases the risk of postoperative RV failure. Once this occurs, the treatment is complex. The available therapeutic measures include the use of vasodilators such as prostaglandin E1 and nitric oxide.