Improved echocardiographic equipment provides detailed images of the heart and shows anatomic paraseptal structures previously not well defined. Echocardiograms were analyzed from 33 patients who later underwent cardiac transplantation, and the paraseptal structures noted were correlated with the pathologic specimens. Patterns associated with right ventricular chordae tendineae, the moderator band and the posterior papillary muscle are illustrated. Hypertrophic and fibrotic right ventricular trabeculae and left ventricular paraseptal bands are noted. These structures can be specifically sought and identified using the current generation of echocardiographs, thereby avoiding potential problems of septal definition and measurement.