SummaryFetal echocardiography is a widely accepted approach to the prenatal diagnosis of congenital heart disease. Many types of structural and functional abnormalities have been reported, although those affecting the four-chamber view of the heart are most accurately diagnosed. Screening for heart disease with the four-chamber view is becoming accepted as a part of general obstetric sonography. Indications for fetal echocardiography and the implications of abnormal findings are reviewed. The most common fetal arrhythmias and treatment strategies are reviewed. Finally, counseling principles and long-term outcomes are discussed.