The incidence of foramen ovale restriction or closure is greater in fetuses with congenital heart defects (CHDs) and obligate atrial shunting and/or left atrial hypertension. Foramen ovale restriction or closure in fetuses with CHD can cause distress in utero or at birth. We suggest performing serial ultrasound assessment for at-risk fetuses with CHD to best assure fetal well-being plan the timing and mode of delivery, and develop management protocols for in utero and postnatal care. The future for these patients may be more optimistic as fetal intervention procedures are developed and mastered.