Congenital heart diseases (CHD) are frequent fetal anomalies, with an important impact on perinatal mortality and morbidity. Prenatal diagnosis has a demonstrated effect in decreasing the overall prevalence at birth, and in improving the outcomes of specific malformations; moreover, the great majority of these malformations occurs in the absence of any risk factor. All of these features strongly evidence the need for a screening test that can be applied to the general population, to identify a selected group of fetuses for the more specific, complex, and time-consuming diagnostic test (fetal echocardiography). The systematic visualization of the four chamber view and the outflow tracts during routine anatomical scan has progressively increased the prenatal detection rate of CHD. However, a number of potentially diagnosable defects are still missed in the screening setting. Three-dimensional ultrasonography could provide a useful tool to ameliorate the current performance of CHD screening; however this possibility needs to be further explored.