Imaging with echocardiography is useful in diagnosing congenital heart disease (CHD). Two-dimensional (2D) transthoracic echocardiography (TTE) has been the standard cardiac imaging modality, but it forces the reader to mentally create the three-dimensional (3D) cardiac anatomy to understand these complex diseases. 3D TTE, which has relatively recently emerged to address this limitation, is capable of providing clear and dynamic 3D views of these anatomic defects and offers more insight on how to manage them. This review article will address the benefit of utilizing 3D TTE for proper characterization of different types of CHD in the adult and as a guide to appropriate treatment. (Echocardiography 2013;30:483-494).