In valvular heart disease, there is a different radionuclide angiographic pattern in each of three left-sided valve abnormalities: pressure overload (aortic stenosis), volume overload (aortic or mitral regurgitation) and inflow obstruction (mitral stenosis). In pressure overload, the left ventricle is usually normal in size or minimally dilated. The ejection fraction may be normal, increased or decreased. In volume overload, there is left ventricular dilatation with a normal or reduced ejection fraction at rest. Scans may be performed during exercise to unmask abnormalities of ventricular function not evident at rest. In inflow obstruction, left ventricular function is usually normal but may be depressed. Right ventricular function may be abnormal secondary to pulmonary hypertension. Radionuclide angiography in valvular heart disease evaluates the impact of the valve abnormality on cardiac chamber size and function, which is useful in managing the patient, in determining the prognosis and in evaluating the success of valve surgery. Thallium-2-1 imaging evaluates regional myocardial blood flow and cell integrity and can be used to assess associated coronary artery disease.