The current chapter describes from a historical backgound to current times, the evolution of fetal cardiac examination by using three-dimensional (3D) ultrasound. The diagnostic enhancement obtained with the application of the 3D ultrasound technology was possible from the advent of the spatio-temporal-image correlation (STIC)™ two decades ago, a software that enables the real-time anatomic reconstruction of the fetal heart during one complete cardiac cycle. Deatiled description of the technical advancement by which two developed 3D softwares e.g. the HDlive™ and its enhanced version the Silhoutte™ mode are also reported. These 3D ultrasound applications rely on the possibility to adjust a light source orientation generating either illumination as well as shadowing with the final result of a realistic imaging. Clinical validation and applications to the study of the cardiac structures during first, second, and third trimesters are also described. Nowadays, HDlive™ and Silhoutte™ modes have been usefully introduce in daily practice and are part of the modern 3D armamentarium used in screening as in extended, referral fetal echocardiogram investigation.