Improvements in prenatal diagnostic techniques have led to renewed interest in fetal cardiac intervention. The restoration of more normal flow and pressure relationships in the developing heart may encourage normal or near normal growth and function, improving the postnatal outcomes and surgical and medical options. Exteriorization of the fetus and surgical intervention has been performed, but the inevitable development of premature labor remains a major obstacle to the development of fetal cardiac surgical techniques. Improvements in fetal imaging techniques are compatible with interventional catheterization methodology. The technical feasibility of aortic valve dilation in the fetus using new, low-profile coronary balloons and wires to dilate aortic valves in fetuses likely to acquire hypoplastic left heart syndrome without intervention has recently been demonstrated. Additionally, there has been some success in creating atrial communications in fetuses with premature closure of the foramen ovale in association with left sided obstruction. Attempts have also been made to re-establish communication between the right ventricle and pulmonary arteries in fetuses with valvar pulmonary atresia. Issues of patient selection, timing and outcome are only beginning to be addressed, and the clinical utility of prenatal interventions is yet to be determined.