The four-chamber view is fundamental to fetal echocardiographyFetal echocardiography, as it will show some, but not all the evidence for most fetalFetal cardiac abnormalities. The four-chamber viewFour-chamber view provides the base view from which further views can be developed and is fundamental in the assessment of ventricular proportions and imbalance, ventricular inlets, evaluation of the crux and for septal defectsSeptal defects. Additionally, the four-chamber view is the ideal view for initial evaluation of heartHeart rhythm and extracardiacExtracardiac abnormalities such as a pericardial effusion, mass lesions and abnormalities of heartHeart position. This chapter will explore abnormalities seen in the four-chamber viewFour-chamber view and discuss common associations and outcomes for each lesion to guide counsellingCounselling.