Postoperative pulmonary edema secondary to diastolic dysfunction in a patient with a previous heart transplant

Left ventricular diastolic dysfunction with preserved contractility is being recognized with increasing frequency. We describe a 53-year-old man who had undergone heart transplantation 10 years previously, who was now scheduled for renal biopsy for progressive and unexplained decline in renal function. Hypertension from pain or a stress response, increases in preload, and tachycardia predispose patients with chronic left ventricular diastolic dysfunction to pulmonary edema. Prompt and accurate diagnosis is essential for treatment. We recommend echocardiographic assessment of diastolic function when preoperative evaluation of left ventricular function is considered for these patients.