In children, the fact that cardiac anatomy and function, particularly during the diastolic phase, can adapt to endurance training is still uncertain. Therefore, this study was undertaken to evaluate the effect of a long-term intensive endurance swimming program on the cardiac structure and function of 10-11 year old children. The population consisted of 9 children who belonged to a local youth swimming team (S) and 11 recruited from a primary school to serve as a control group (C). The swimmers had been training on average 10 to 12 h x wk(-1) for at least 2 years. All the subjects were examined by M-mode, 2-dimensional and pulsed-wave Doppler analyses according to standard procedures recommended by the American Society of Echocardiography. Investigations were carried out at rest with the subjects in a supine position. The results showed that highly trained children exhibited significantly higher left ventricular (LV) internal diameter (S: 41.6+/-1.6, C: 39.0+/-2.2 mm/m(1/3) surface area, p<0.01) and LV mass (S: 68+/-7, C: 59+/-5 g/m2 SA, p<0.01). There were, however, no differences between S and C for chamber wall thickness (posterior wall S: 5.2+/-0.6, C: 5.3+/-0.6 mm/m(1/3) SA; septum S: 5.8+/-0.3, C: 5.8+/-0.4 mm/m(1/3) SA), LV systolic function parameters (ejection fraction S: 77.1+/-0.3, C: 77.7+/-0.4%; shortening fraction S: 38.9+/-3.0, C: 39.7+/-4.1%) and the diastolic function parameters, estimated from LV inflow velocitometry (E wave S: 1.04+/-0.12, C: 1.07+/-0.16 m/s; A wave S: 0.45+/-0.10, C: 0.55+/-0.11 m/s). Finally, transaortic Doppler examinations demonstrated similar resting cardiac output (Qc) between both groups (S: 3.76+/-0.81, C: 3.90+/-0.67 l x min(-1)). However, Qc were obtained with significantly lower heart rates (S: 69+/-7, C: 83+/-14 beat x min(-1), P<0.01) and higher stroke volumes (S: 55.2+/-8.0, C: 47.5+/-8.5 ml, P<0.05) in S when compared to C. Thus, these findings strongly suggest that, as has been shown before in adults, several cardiac adaptations (including resting bradycardia, increased stroke volume and enlarged left ventricular internal dimensions) can occur in prepubertal children as a result of intensive endurance training. However, our results did not demonstrate any effects of such training during prepuberty on both diastolic and systolic functions parameters.