To assess intramyocardial blood flow distribution by the contrast echocardiographic technique, we studied the effect of intracoronary injections of contrast agents on the echo intensity of the myocardium. As fundamental experiments, we made injections of ICG, urografin, artificial blood (FC-43) and microsphere into the coronary artery in open chest dogs and observed the changes in echo density of the myocardium. Bolus injection of 10 ml ICG into the coronary artery produced little change in the myocardial echo intensity, but bolus injection of 10 ml urografin, FC-43 and microsphere into the left circumflex coronary artery (LCX) and left anterior descending coronary artery (LAD) immediately increased the echo intensity of the left ventricular posterior wall (LVPW) and interventricular septum (IVS), respectively. Enhanced echo areas correlated well with the regions perfused by LCX and LAD, respectively. Clinically, we recorded two-dimensional echocardiograms during coronary arteriography (CAG) in 10 patients. In six of the 10 patients, the echo intensity of IVS increased during left CAG and in four of eight patients the echo intensity of LVPW increased during right CAG. Contrast echomyocardiography, contrast enhanced echocardiography of the myocardium, proved a useful technique for the evaluation of intramyocardial blood flow.