Usually described thus far in the left ventricle, it is typically associated with abnormal systolic function, albeit also recorded with restrictive physiology and segmental hypokinesis. 1-5 Seen most frequently in the structurally normal heart, increasing recognition shows that the lesion can also accompany diverse forms of congenital cardiac disease (Figs 1 and 2). 1-10 When seen in the left ventricle, it is currently considered an unclassified form of cardiomyopathy, being neither dilated, hypertrophic, nor restrictive. 2, 3, 11, 12 Although once considered rare, 13-15 it is now being seen with increasing frequency, from the fetus to the adult. 16-29 Diagnosis has now moved from the autopsy table to recognition during life, albeit the debate continues with regard to the features displayed by angiography, echocardiography, computed tomography, and magnetic resonance imaging that permit unequivocal recognition. Subsequent to this initial description, many others, noting the presence of these changes, have again invoked the concept of evolutionary persistence of the spongy myocardium typically seen in the ventricular walls of some fish, amphibians, and reptiles. 21, 30-32 Since the original description of the spongy arrangement, many other terms have been used to describe the abnormal morphology, including spongiform cardiomyopathy, myocardial sinusoids, hypertrabeculations, embryonic myocardium, anomalous ventricular myocardial patterns, dysplastic cardiac development, isolated left ventricular abnormal trabeculation, myocardial dysgenesis, ventricular dysplasia, honey-combed ventricle, as well as still other miscellaneous offerings. 1, 5-10, 32-35 Until the last decade, it was the designation of" spongy myocardium" that held sway, although less so more recently.