The subspecialty of pediatric cardiology has rapidly progressed in the past few years with more children with heart defects surviving to adulthood. With newer diagnostic tools and improved surgical techniques, many heart defects are being approached with surgery. Although the more complicated lesions are never "completely repaired" and may require heart transplant in the long-term, there is an approach to "palliation." Most of the congenital heart malformations are detected in the perinatal period and this article gives the reader a general picture of the diagnostic approach to a multitude of heart defects.