The field of pediatric cardiology has changed significantly over the past decade. The epidemiology of congenital heart disease (CHD) is shifting, with increased prenatal diagnosis, improved survival, and improved imaging and intervention techniques. Long term issues including neurodevelopmental outcome, exercise capacity, quality of life and reproduction have become more important as children survive their heart disease into adulthood. Neonatal oximetry screening is becoming routine practice to ensure that the majority of critical CHD is diagnosed as early as possible, as this has a positive impact on outcome. Imaging techniques in pediatric cardiology are evolving rapidly. Echocardiography remains the mainstay of imaging, with new techniques of 3D imaging and advanced function assessment adding to its utility. Cardiac MRI and CT are becoming important adjunct imaging techniques, particularly due the 3D and spatial information obtained. Cardiac catheterization with angiography is utilized less as a solely diagnostic technique, but has a substantial and increasing role in non-surgical intervention for CHD. Genetic testing in pediatric cardiology is adding yet further information regarding diagnosis, treatment options and prognosis in CHD, cardiomyopathies and cardiac channelopathies.