We sought to evaluate the economic aspects and benefits of adding a limited screening echocardiogram to our annual athletic preparticipation examinations. It was our belief that this screening echocardiogram would add valuable information beyond the history and physical exam alone and could be included in our station-by-station format with little increase in time or cost. Controversy exists concerning the best method of detecting cardiovascular conditions that may predispose the athlete to sudden death. During our 1992 preparticipation examinations, we included a single-view parasternal long- and short-axis two-dimensional screening echocardiogram. This screening can detect four potentially fatal congenital heart defects. We performed a total of 2,997 echocardiograms at an average cost of $7.34 per examination. Overall 64 echocardiographic abnormalities were found. Mitral valve prolapse and bicuspid aortic valve were the two most common abnormalities. The sensitivity of the history and physical examination in detecting cardiovascular abnormalities was extremely low. Incorporating the echocardiogram into our station-to-station format did not add a significant amount of time to the overall process. We conclude that a screening echocardiogram provides important information and can be used efficiently and economically in the athletic preparticipation examination.