CARDIAC COMPLICATIONS OF MARROW TRANSPLANTATION

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, effu sive pericarditis, and arrhythmias, are regimen-related toxicities due to cyclophosphamide and ifosfamide. These are most common in the pres ence of pre-existing anthracycline cardiac toxicity. Patients with bas eline ejection fractions less than 50% have a higher incidence of card iac toxicity. Radiation and other transplant-associated agents (etopos ide, taxol, etc.) are known to have potential, but less frequent, card iac toxicities. It may be clinically difficult to distinguish cardiac problems from other processes, such as pulmonary toxicity, volume over load, or sepsis-related myocardial depression. Additionally, pericardi al, myocardial, and valvular infections are potential, rare causes of complications and may pose diagnostic challenges. While there is no co nsensus regarding the pre-transplant evaluation of left ventricular fu nction, general guidelines for management issues, both before and afte r transplant, can be made.