The purpose of this study was to determine the accuracy of a new high frequency echocardiographic technique for the quantitative assessment of coronary artery luminal and wall dimensions. In 32 open chest animals, high frequency echocardiographic measurements (echo) of luminal diameter correlated well with in vitro histologic measurements (Histo) (r = 0.86; high frequency echo = 0.89 Histo + 0.79) (range 1.7 to 5.8 mm). Similar results were found in the evaluation of five human autopsy hearts studied in vitro. Coronary artery wall thickness measurements in human autopsy hearts showed a good correlation with high frequency echocardiographic measurements (r = 0.86; high frequency echo = 0.65 Histo + 0.24) (range 0.3 to 0.8 mm). In eight open chest calves, high frequency echocardiographic measurements of total vessel diameter correlated well with sonomicrometer measurements (Sono) (r = 0.94; high frequency echo = 1.03 Sono + 0.4) (range 2.1 to 5.3 mm). Inter- and intraobserver variability measurements of high frequency echocardiographic measurements demonstrated excellent reproducibility (r = 0.95, interobserver variability for wall thickness; r = 0.97, interobserver variability for luminal diameter; n = 10 postmortem human coronary arteries). In conclusion, high frequency echocardiography is an accurate and reproducible method of measuring coronary luminal and wall geometry and may be a potentially useful tool for in vivo coronary artery evaluation in patients.