Adults with a nonrestrictive ventricular septal defect are characterized by cyanosis, systemic right ventricular hypertension, and, in most cases, normal systolic function of both the right and left ventricles.(1,2) Ultrasonic tissue characterization, however, revealed abnormal cyclic variation of integrated backscatter, suggesting alterations in myocardial structure in these patients.(2) Diastolic filling of the left ventricle has not been characterized, but may also be abnormal.