Orthoptic heart transplantation (OHT) is a life-saving procedure that has substantially improved the lives of countless patients since its inception. However, there are several procedure-related complications that require prompt management. Interventional radiology, with its ever-expanding toolkit, is a cornerstone of the multidisciplinary team following post-cardiac transplant patients. Percutaneous, endovascular therapy provides minimally invasive, safe, and effective treatments for immediate and delayed cardiac transplant complications and this paper serves to highlight the various management options interventional radiology can provide for orthoptic heart transplantation complications.