'Incisura' of the ascending aorta and vascular pedicle width in the cardiac transplant patient

Background. The purpose of this study was to evaluate three findings in cardiac transplant patients: the appearance, etiology, and incidence of 'incisura' (a characteristic indentation) of the ascending aorta; the vascular pedicle width, which usually appears enlarged on standard chest radiographs; and clearing of the retrosternal clear space. Material. Two hundred sixty-one cardiac transplantations were performed at the University of Minnesota before December 31, 1992. The appearance, etiology, and incidence of an incisura were studied; the vascular pedicle width was measured; and the rate of clearing of the retrosternal clear space was determined. Results. Forty-six percent of the patients whose ascending aorta could be visualized on the lateral chest radiogram showed an incisura. Approximately one third of the patients showed continued opacification of the retrosternal space postoperatively. The width of the vascular pedicle in this series of cardiac transplant patients measured 60.9 ± 22.8 mm (standard deviation, 11.4 mm), in comparison to a normal of 48 ± 5.0 mm. Conclusions. An incisura of the ascending aorta and the widened vascular pedicleare normal postoperative chest radiographic findings in cardiac transplant patients and should not be misconstrued as abnormalities.