Preparticipation physical examination (PPE) typically results in a 0.3%–1.3% denial of participation for various reasons including cardiovascular (CV). Although two-dimensional echocardiography (2-D echo) is the most sensitive test for detecting CV disease, 2-D echo has not typically been part of the PPE because of its high cost. A portable machine has allowed the cost of a 2-D echo to decrease considerably, but its role in routine PPEs is not known. PURPOSE To determine the impact of the portable 2-D echo machine in screening for CV disease in school-age athletes referred for PPEs. METHODS In 2001, we performed PPEs on 1566 school-age athletes (age 12–21 yrs) in the Chicago metropolitan area. During each PPE, the athlete received a portable 2-D echo (1–2 minutes). Short axis and parasternal long axis views were obtained for septal thickness (abnormal ≥ 1.3cm), size of left ventricular cavity, width of the aortic root (abnormal ≥ 3.8cm), and the appearance of the aortic valve. Participation in sports was denied if an abnormality was detected and further evaluation was recommended before participation could be allowed. RESULTS Overall denial rate was 4.95%(81 of 1566 PPEs): 17, abnormal septal thickness; 14, murmur, chest pain or palpitations; 11, hypertension; 10, visual abnormalities; 9, orthopedic abnormalities; 7, uncontrolled asthma; 4, recent surgery; 3, abnormal aortic root; 3, unexplained dizziness; 1, seizure dosorder; 1, enlarged heart 2-D echo; and 1, eating disorder. 2-D echo accounted for 26% of the denials, and increased the denial rate from 3.9% to 4.95%. Of the abnormal portable 2-D echoes, only one athlete was found to have a newly diagnosed dilated cardiomyopathy. No episodes of hypertrophic cardiomyopathy or Marfans were detected. CONCLUSIONS Portable 2-D echo can be performed quickly and inexpensively during the PPE. It increases the rate of denial of participation in sport by 1.05%. In this group of school-age athletes the incidence of newly diagnosed CV disease was low.