To evaluate the accuracy of Doppler echocardiography for measuring the interventricular pressure gradient in patients with ventricular septal defect (VSD), Doppler echocardiography and dual catheters were performed simultaneously in 31 cases with VSD ranging from 9 to 40 years old. The systolic jet velocities through VSD were recorded by the continuous-wave Doppler technique and converted to the peak instantaneous pressure gradient (delta Pp) and the mean pressure gradient (delta Pm) using a modified Bernoulli's equation with the aid of computer system. Both left and right heart catheters were performed to record the left (LVSP) and the right (RVSP) ventricular systolic pressure simultaneously. Guided by the color flow image Doppler technique, the tip of the right heart catheter was carefully placed within the jet area of the right ventricle. The following parameters were measured from the ventricular pressure curves, the peak instantaneous pressure gradient (IPG), the peak to peak pressure gradient (PPG) and the mean pressure gradient (MPG). The comparison between delta Pp and PPG yielded an excellent correlation (r = 0.99, SEE = 0.69 kPa). There was a close agreement between delta Pp and IPG (r = 0.99, SEE = 0.64 kPa). However, the correlation between delta Pm and MPG was also high (r = 0.98, SEE = 0.67 kPa). We conclude that Doppler echocardiography offers a reliable technique for measuring the interventricular pressure gradient in patients with VSD.