Examination of the fetus offers a unique opportunity to understand the true scope of congenital and early acquired cardiac lesions. Diagnosis and management of arrhythmias remain the predominant use of these techniques. Structural heart disease can be completely characterized by two-dimensional and Doppler examination. Such studies enhance our understanding of heart disease and also provide the family and patient care team with valuable information for the planning of neonatal management. These advances in technology and emphasis on increased fetal salvage are expected to usher in the next age of surgical intervention in the fetus with structural heart disease. The ability to examine the fetus at increasingly earlier stages of gestation will provide invaluable means for unraveling the secrets of the origins of many cardiovascular alternations.