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One hundred sixteen hearts of children dying with leukemia during the 5-year period of 1962 to 1967 were examined at necropsy. Forty-four per cent of the patients had at least one focus of leukemic infiltration, a slightly higher incidence than previously reported. The evidence suggests that peripheral leukocyte count, type of leukemia, and length of survival are factors that influence cardiac infiltration. Increased survival time due to improved therapy may explain the increase in percentage of hearts with leukemic infiltration. Electrocardiographic patterns, in general, were found, as previously reported, to be nonspecific for leukemic myocardial infiltration. Cardiac hypertrophy of significant degree was found in 33 of 99 hearts evaluated for this aspect. Anemia, intrinsic to leukemia, is proposed as the principal factor responsible for this hypertrophy inasmuch as all possible alternate mechanisms were excluded and since previous clinical as well as experimental animal studies clearly have shown that chronic anemia frequently results in cardiac hypertrophy regardless of the etiology of the anemia.