AbstractA technique is described for doing the echocardiographic examination with the transducer in the subxiphoid region instead of along the left sternal border (routine examination). This examination has proved to be extremely useful in patients in whom the routine examination was difficult. These patients include those with emphysema and large barrel chests. The examination is most successful in patients whose diaphragms are depressed. In patients whose diaphragms are elevated due to marked obesity, ascites, or distended abdomens this subxiphoid examination may be very difficult. In those patients in whom both routine and subxiphoid examinations were performed the ultrasonic dimensions of the left ventricle were quite comparable with both approaches. However, there were some significant differences in the measurements of the right ventricle with the two examinations. Technically satisfactory examinations of the aorta and left atrium were inconsistent with the subxiphoid approach. Thus the subxiphoid examination was most useful for examining the left ventricle. Since the subxiphoid examination views different areas of the left ventricle, the technique holds promise of providing a means of examining areas of the heart not visualized with the routine approach.