In the chapter, the 2D, color Doppler and 4D features of major conotruncal abnormalities will be described. In particular, the echocardiographic views on which the various lesions are detected will be described. In addition, the role of color Doppler in the recognition of valve stenosis or insufficiency will be illustrated. Finally, the diagnostic role of 4D echocardiography will be described, only in those cases in which it has additional clinical value. Videos of major diagnostic features are also provided, to facilitate the understanding of the text.