We report 2 cases of acquired supravalvar aortic stenosis (SVAS) complicating orthotopic cardiac transplantation that contributed to the post-operative death of both patients. In the first patient the stenosis resulted from kinking of a too-long graft aortic component that was rendered into a fixed deformity by healed mediastinitis and constrictive pericarditis. Supra-aortic stenosis in the second patient occurred at a site of multiple aortic cannulations that was surrounded by dense fibrosis. Acquired SVAS contributed to the death of the first patient (who had graft arteriopathy) and was the proximate cause of death in the second patient. Specific echocardiography of the ascending aorta, which is not routinely performed, may detect SAVS.