CLINICAL PERSPECTIVE: The first prospective trial in which both echocardiography and Doppler color flow imaging (echo-DCFI) are used routinely during surgery for congenital heart lesions has been undertaken at Duke Medical Center. Precardiopulmonary bypass (CPB) echo-DCFI examinations have revealed previously unsuspected cardiac findings in several of the patients. These examinations have influenced the surgical course in some way in many of the cases. Post-CPB ultrasound evaluation of the quality of the surgical repairs alone has resulted in immediate additional corrective surgery in several patients, most of whom then left the operating room with an optimum repair.