BACKGROUND: In geriatric patients, cardiovascular disease is common and a main cause of perioperative morbidity and mortality. Therefore preoperative evaluation of cardiac function is important. The purpose of this study is to evaluate preoperative echocardiography in geriatric patients for understanding aging heart changes and proper selection of patients. METHODS: In the 381 geriatric patients, authors evaluated chamber size, wall thickness, wall motion, valve abnormalities and ejection fraction. In addition, in patients who had left ventricular dysfunction (ejection fraction < OR = 55%), authors evaluated past medical histories and electrocardiographic (ECG) findings. RESULTS: Left atrial enlargement was present in 16%, left ventricular enlargement in 3%, right ventricular enlargement in 6%, ascending aorta dilatation in 13% and left ventricular hypertrophy (LVH) in 28%. Aortic regurgitation (AR) was present in 44%, mitral regurgitation (MR) in 42%, aortic valve calcification in 21% and hypokinesia of the left ventricular wall in 4%. Left ventricular dysfunction was present in 18 patients and their past medical histories showed hypertension in 39%, myocardial ischemia in 33%, congestive heart failure in 28% and diabetus mellitus in 28%. Also their ECG findings showed LVH in 45%, atrial fibrillation in 30% and ventricular premature contraction in 15%. Among the 18 patients with left ventricular dysfunction, 16 patients (89%) had dyspnea or heart disease histories such as myocardial ischemia, myocardial infarction, congestive heart failure, premature ventricular contraction and atrial fibrillation. CONCLUSIONS: 16% of the patients showed a normal echocardiograpy. Abnormal findings of the echocardiography were, in order of frequency, AR (44%), MR (42%) and LVH (28%). Dyspnea or cardiac disease histories were present in 89% of the left ventricular dysfunction patients.