A case of severe refractory hypotension following a cardiac transplant is presented. In the hours after surgery, vasoplegia was diagnosed in the intensive care unit after exclusion of common causes of hypotension after cardiac surgery. Vasoplegia after cardiac surgery is a condition characterised by severe systemic hypotension, low systemic vascular resistance and a normal to high cardiac output which is often refractory to conventional vasopressor therapy and fluid administration. The pathophysiology is still incompletely understood but seems to be related to several preoperative factors as well as the use of the cardiopulmonary bypass. As this phenomenon is associated with an increased morbidity and mortality, proper recognition is essential although treatment options are limited.
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