The population of adults with congenital heart disease (CHD) is rapidly growing as a result of improvement in diagnostic techniques, medical and surgical expertise. It is estimated that 85% of infants born with CHD survive into adulthood, some of whom have never had any intervention or surgery. This patient population represents a heterogeneous group that includes simple defects such as atrial septal defects, ventricular septal defects, pulmonary stenosis, coarctation of aorta, and complex defects such as Tetralogy of Fallot, Ebstein’s anomaly, pulmonary atresia, transposition of the great artery, and univentricular heart. Adults CHD survivors have special needs and require expertise care even after surgical repair since there is usually no cure after repair of CHD and many residua and sequelae are being recognized. The challenges of caring for these adult survivors of CHD can be diagnostic, medical, electrophysiologic, surgical, and psychological. Many of these patients require reoperation that should be performed by surgeons with expertise in that field. The improved outlook for adults with CHD could be best sustained by having adult congenital specialists working in close collaboration with electrophysiologists, cardiac surgeons, cardiac imaging including echocardiography (ECHO), magnetic resonance imaging, computer tomography, as well as obstetricians, psychiatrists, intensivists, transplant service, and medical subspecialists. This multidisciplinary approach toward the care of adults with CHD is the best we can offer for these survivors. This chapter will illustrate the most important echocardiographic features of the common CHD seen before and after repair.