Congenital heart disease(CHD) is the most common congenital abnormality in human fetus, accounting for more than half of deaths from congenital abnormalities in childhood. Fetal echocardiography has been shown to be able to identify the majority of structural cardiac abnormalities, and it has traditionally been reserved for pregnancies at high risk for CHD. Most neonates with CHD, however, have no identifiable risk factors. When a sonogram is performed during pregnancy for defined clinical reasons, a four-chamber view of the fetal heart is routinely performed. However, a four-chamber view of the fetal heart does not reliably detect the most common CHD such as ventricular septal defect, coarctation of the aorta, transposition of the great arteries, and tetralogy of Fallot. Therefore, the vast majority of cases of CHD are left undetected even in those women who have undergone an obstetric ultrasound. A high level of suspicion of the presence of CHD and attention to anatomic details should be part of every ultrasound examination, especially when involving low-risk pregnancies, and it is currently recommended that only those fetuses with significant risk factors be referred for a targeted sonogram and fetal echocardiogram.