Cardiovascular disease (CVD) remains the leading cause of maternal mortality, Pregnant women with known heart disease require careful multidisciplinary teams to assess for maternal and fetal risk. Echocardiography remains the preferred modality for diagnosis and monitoring and assessing the severity of pre-existing structural disease. Among women with pre-existing cardiovascular disease who become pregnant—as well as those who develop cardiovascular symptoms during pregnancy—and is recommended as the first-line imaging modality when appropriate by both the American College of Obstetricians and Gynecologists (ACOG) and the Food and Drug Administration (FDA). as it is widely available and does not require radiation. To highlight the importance of this safe cardiac imaging for early detection and management of cardiovascular issues during pregnancy these evaluations can significantly impact prenatal care, delivery planing and neonatal outcomes.