Familiarity with congenital heart disease (CHD) and its manifestations in adults is becoming increasingly important for the practicing cardiothoracic imager. The use of computed tomographic angiography is becoming commonplace not only in adults with a history and subsequent interventions for CHD as a child but also in de novo detection of—typically—milder, survivable forms of CHD, which are clinically suspected because of declining cardiac performance, cardiac events, or murmurs. Occasionally, adult CHD (ACHD) is found incidentally on scans performed for other indications (eg, trauma or neoplasm staging) because of improvements in computed tomographic technology and advanced visualization. A growing number of patients with CHD survive into adulthood and lead essentially normal lives all over the world and may present in community hospitals and emergency rooms to receive care. Advancements in computed tomographic angiography technology have further allowed us to individually tailor cardiovascular scans according to the patient’s anatomy and specifically for the clinical question raised, aiming at reduced exposure to iodinated contrast and radiation dose, while obtaining diagnostic-quality images. This task, however, is not simple. There is no one-size-fits-all cardiac scan that serves as a one-stop shop for ACHD patients. Careful planning and patient preparation, close supervision of the scan, sophisticated postprocessing, and interdisciplinary interpretation of the findings are all required ingredients for managing patients with ACHD. In this review we highlight the technical principles that should be observed to optimize imaging in ACHD. We also provide practical insight into how specific clinical questions can be answered utilizing this technology in the most frequently encountered forms of ACHD.