Echocardiography is now an integral part of the assessment of patients before, during and after cardiac surgery. For example, mitral valve repair or myectomy would rarely now be contemplated without echocardiography. Echocardiography is essential for the correct diagnosis of valve disease and to plan the appropriate timing of valve surgery, for the assessment of left ventricular function, for the detection of many postoperative complications, and for the follow up after valve surgery or repair of aortic dissection. Although surgeons are increasingly well trained in echocardiography, a specialist in the technique is still required in order to keep abreast of the dramatic advances in technology and interpretation which have occurred over the past five years and which continue unabated.