OBJECTIVE To assess the accuracy of Doppler-echocardiography in the diagnosis and management of the child with heart disease. METHODS Prospective echocardiographic study of 132 consecutive patients aged 1 day to 16 years old with heart disease confirmed by cardiac catheterization (n = 109) or anatomic examination (surgical = 21, necropsy = 2). RESULTS Of the 258 cardiovascular anomalies diagnosed by cardiac catheterization and anatomical examination, 247 were correctly identified by echocardiography (sensitivity = 96%). There were 11 missed and 4 false positive diagnosis (specificity = 98%), all of them were vascular anomalies. Intracardiac anatomy and segmentary alignment were always correctly identified. The 21 cardiovascular anomalies operated without cardiac catheterization were correctly diagnosed. In 16 patients (12%) a management plan could not be established only on clinical echocardiographic grounds and, in another patient, the plan was incomplete. In the remaining 115 patients (87%) the management plan was correct and complete. CONCLUSIONS The clinical-echocardiographic study allows: 1) an excellent anatomo-functional evaluation of the heart and great vessels, 2) surgical repair of some selected cardiovascular anomalies without previous cardiac catheterization.