The preoperative and postoperative chest radiographs of 44 patients undergoing 45 orthotopic cardiac allografts were evaluated retrospectively. Patients were followed from two months to four years postoperatively. Radiographic findings were correlated with echocardiograms and endocardial biopsies. The postoperative cardio-pericardial silhouette stabilized in size by six months. Contrary to previous reports, any marked increase in size of the cardiac silhouette in this series was due to pericardial effusion and not to cardiac rejection. Unusual postoperative features of the chest radiographs included calcification of the residual native left atrium, localized pericardial effusion simulating a left ventricular aneurysm, and a prominent left atrial appendage.
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