Objective: Aim of this study was to investigate the effect of weight loss on structural and functional myocardial alterations in severely obese subjects treated with bariatric surgery. Patients and Methods: Thirteen severely obese patients (2 males and 11 females) were enrolled in the study. All subjects underwent conventional 2D color Doppler echocardiography. The new ultrasonic techniques used were: (a) integrated backscatter for the analysis of myocardial reflectivity, referred to pericardial interface as expression of myocardial structure (increase in collagen content) and of cyclic variation index as expression of intrinsic myocardial contractility and (b) color Doppler myocardial imaging (CDMI) for the analysis of strain and strain rate (myocardial deformability). All subjects underwent bariatric surgery and were resubmitted to echocardiographic and biochemical examination 6–24 months after surgery. Results: The main finding of the present study was a quite complete normalization of myocardial functional and structural alterations after weight loss. In particular, the cyclic variation index at septum level improved from 14.6 ± 7.0 before to 25.7 ± 11.2 (means ± SD) after surgery (controls: 36.2 ± 9.1). Mean reflectivity at septum level significantly decreased from 55.8 ± 9.5 to 46.5 ± 8.8 (controls: 43.0 ± 8.0). Also, the strain at septum level significantly improved after surgery (from –11.9 ± 3.2 to –20.4 ± 5.3; controls: –23.4 ± 9). Conclusion: This study establishes: (a) the utility of new ultrasonic techniques to detect very early structural and functional myocardial alterations in severely obese patients, and (b) the regression of these subclinical abnormalities after weight loss achieved by bariatric surgery.