OBJECTIVES Current health care management has resulted in a change in referral patterns. The present study was undertaken to define the efficacy and value of pediatric echocardiography performed and interpreted in adult laboratories. METHODS We reviewed the findings in 100 consecutive pediatric patients 1 month to 18 years of age referred for possible heart disease and evaluated previously by echocardiography performed in an adult laboratory. Technical adequacy and interpretation of the echocardiogram at the outside facility was correlated with our final diagnosis. RESULTS Of the studies, 32 (32%) were performed in hospital laboratories, and 68 (68%) in physician offices. A total of 52 (52%) of the 100 patients arrived with an outside diagnosis in agreement with our final diagnosis. Technical difficulties were reported in 14 (14%) studies by the original laboratory; we felt that 32 (32%) studies were inadequate. Interpretation or communication between the outside echocardiography laboratory, primary care physicians, and patients' family was erroneous in 32 (32%) cases. Repeat echocardiography was necessary in 38 (38%) patients (6 because of planned surgery). If initial referral had been to our own institution, 25 to 30 patients would not have undergone echocardiography. CONCLUSIONS Slightly more than half of echocardiography studies performed in pediatric patients in adult laboratories were technically adequate and interpreted correctly with proper physician-family communication. Many patients require repeat studies on further referral. A significant number would be spared echocardiography if they were sent to a pediatric cardiology center initially.