Cardiac transplantation, as the technique was described by Lower and Shumway, has become the standard method for treating end-stage heart disease until the beginning the decade. In this technique establishment of venous communication was simplified with atrial cuffs. However, the losses of atrial anatomy, high incidence of mitral and tricuspid valve regurgitation and atrial arrythmias have allowed an alternative technique, the bicaval technique, to gain popularity. Twelve orthotopic cardiac transplantations with standard technique (group A) and 10 transplantations with bicaval technique (group B) were enrolled in this study to evaluate the effect of surgical technique on alteration in the dimensions of atriums and the competence of the atrioventricular valves. All patients were assessed with transthoracic echocardiography on a regular basis. The data obtained in the first and sixth months after transplantation were evaluated in this study. The mean right atrial dimension was larger in group A. The incidence of mitral and tricuspid valve regurgitation did not show any difference between the two groups. There was no difference regarding the progression of atrial dilation or incidence of atrial arrhythmias. Although there was no statistically significant difference between the two groups, bicaval technique is now preferred by restoring near normal anatomic reconstruction.