To assess the value of intraoperative transesophageal echocardiographical Doppler color flow imaging (TEE-DCFI) during cardiac valvular surgery, 85 consecutive patients with 102 diseased valves for surgery were studied with pre-and post-operative TEE-DCFI. There were 34 women and 51 men with an age range of 15 to 55 years (mean age, 34.91 +/- 9.33 years). The etiology of valve lesion was rheumatic in 57 (AV 10, MV 47), prolapse in 9 (AV 2, MV 7), endocarditis in 21 (AV 12, MV 3, PV 2, prosthetic infection 4), prosthetic dysfunction in 14 (AV 5, MV 9), congenital in 1 (TV). Preoperative TEE-DCFI findings were helpful either in completing with some new information or changing the operation plan in 29 valves (28.43%) including abscess at aortic root in 1, perforation of aortic valve in 2, perforation of mitral valve leaflets in 5 patients with aortic valvular endocarditis, regurgitation or perivalvular leak of prosthetic valve in 4 MVs and 4AVs, left atrial thrombus detected in 8 and excluded in 3 patients with MV disease, small calcified vegetation on PV with normal valve function in 2 patients with congenital heart disease. Postoperative TEE-DCFI evaluation was performed in 53 patients with 70 diseased valves. There was only one mild regurgitation of mitral bioprosthesis and one mild perivalvular leak of aortic prosthesis detected among 40 replaced prosthetic valves. Of 30 valves repaired 23 (77%) valves had trivial or mild residual regurgitation (Group A) and 7 (23%) had moderate residual regurgitation (Group B). Postoperative congestive heart failure was seen in 6 (26.09%) of Group A and 5 (71.43%) of Group B (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)