Aim To determine the reasons, outcome of ante-natally detected congenital heart conditions, incidence with associated co-morbid conditions and the recurrence rate of congenital heart conditions with maternal and fetal conditions in Wales over a period of 7 years 2002–2008.

Methodology Retrospective study of 1747 referrals for tertiary fetal cardiology evaluation. Data were obtained from fetal medicine, radiology, neonatal, cardiology databases and case notes.

Results The incidence of congenital heart disease in Wales in 13 per 1000 live births. 1747 mothers were referred to Tertiary fetal cardiology assessment. Initial echocardiogram was normal in 1305 (73%) of mothers and discharged from follow up. Abnormal cardiac anatomy and family history of congenital heart disease were the main reasons for referral to fetal cardiology. 62% of fetal demise was contributed by Hypoplastic conditions and AVSDs atrial ventricular septal defect. 64% of terminations were due to four chamber abnormalities. Outflow tract abnormalities remains significant in postnatally detected conditions. 88% of the foetuses with major cardiac anomalies were delivered in paediatric cardiothoracic surgical centres.

The incidence of congenital heart disease with maternal insulin dependent diabetes mellitus is 3.7%, with genetic conditions is 30.4% and with associated congenital anomalies is 30%.

The recurrence risk for congenital heart disease with family history is 3.7%, with mother herself having congenital heart disease is 8% and with previous pregnancy having major heart conditions is 6.5%.

Conclusion The incidence of congenital heart conditions in Wales is high. The pickup rate of outflow tract anomalies was significantly improved after sonographers training programme by the fetal cardiologist.