**7.6. Consider echocardiography as a main tool, together with PAC, to guide hemodynamic management, inotropic support, and fluid challenge**

At first, we may exclude significant pericardial collection, assess left ventricle diastolic function of the new performing heart, related to its stiffness and hypertrophy, and think about which wedge pressure we are expected to find [21]. If the systolic function of the new heart is failing, we should exclude an acute graft rejection. Regarding the right ventricle, we must know the recipient preoperative pulmonary vascular resistances, if pre- or postcapillary pulmonary hypertension persists and if it is reversible with phosphodiesterase inhibitors.

RV dysfunction is identified early with a dilation of the right chambers, alteration of interventricular septum movement, and appearance of tricuspid valve insufficiency.
