Total orthotopic and bicaval cardiac transplantation techniques were developed as an alternative to standard technique. We modified the bicaval technique by plicating the left atrium in our clinic. In three patients that have undergone cardiac transplantation, we decreased the size of left atrium by plicating left atrial posterior wall between left and right pulmonary veins. A smooth surface was maintained by our suture technique. Right atrial anastomosis was performed by using bicaval technique. We performed echocardiography in the day of discharge. In these patients the diameter of left atrium was 32.5x50.5 mm, the left ventricle ejection fraction was 51-62% and there was no associated mitral valve insufficiency. In the described technique we believe that a more anatomical and physiological left atrium is created. Therefore we expect a better cardiac performance.