The outcome of cardiac transplantation has improved dramatically over the past several decades, in large part because of improvements in immunosuppression and postoperative management. During the first 2 to 3 weeks after transplantation, patients are closely monitored for evidence of rejection. This includes a percutaneous transvenous endomyocardial biopsy to assess for histological signs of organ rejection and to adjust immunosuppressive medications if necessary. The first cardiac biopsy is usually performed 2 weeks posttransplant, unless earlier signs of rejection occur. The preferred site for vascular access to perform this procedure is through the right internal jugular vein, as the transvenous biotome used to take the biopsies does not need a guiding catheter or sheath when inserted through this approach. Moreover, right-sided cardiac biopsies are associated with fewer complications.