Over the last 15 years, the ultrasound examination of the fetal heart has become increasingly sophisticated. Fetal echocardiography is now paramount in making an early and accurate assessment of cardiovascular structure as well as diagnosing and treating fetal arrhythmias. For the fetal sonographer, the increasing challenge of fetal evaluation has been paralleled by advancing technology. Today, a complete fetal echocardiographic study includes the structural and rhythm analysis using a combination of two-dimensional imaging, M-mode scanning, pulsed- and continuous-wave Doppler measurements, and color-flow mapping. When the data obtained from the fetal echocardiogram suggest normal cardiac structure, the reassurance provided to the family at risk is immeasurable. When a prenatal diagnosis of structural or rhythm abnormalities is obtained, the health care team can outline a management strategy to optimize the care and support given to the fetus, mother, and family.