Clinical applications of echocardiography continue to grow and be refined with the development of newer technology and the resultant increase in clinical studies. The reliability of echocardiography applied to patients with valvular heart disease has been very well established in determining pressure gradient, stenotic valve area, right-sided cardiac pressure, and ventricular responses (dimension and global systolic function) to pressure and volume overload. Less well established are the determination of regurgitation severity, the role of echocardiography in endocarditis, and the use of the echocardiographic information in clinical decision-making. These issues have been dealt with extensively in the most recent literature. Through superb visualization of the native and prosthetic valvular apparatus by transesophageal echocardiography, new morphologic and functional observations continue to be made.