In this paper, a new echocardiographic detection technique of the VP in patients with CPC is described. Subjects who frequently have large, barrel chests, with pulmonary emphysema and markedly depressed diaphragms, are very difficult to examine echocardiographically. By this technique, however, the authors obtained the highest detection rate so far reported (congruent to 100% of the patients studied). Moreover, the echocardiographic findings are validated by an ultrasonic anatomy study based on the use of Cardio Green (V.I.) as contrast agent.