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The main objective of fetal heart ultrasound examination is to diagnose the congenital heart disease prenatally and to give essential information for postnatal treatment and prognosis. Four chamber view (FCV) is the most important plane for screening the fetal heart. The screening performance of the FCV varies according to the population and the examiner’s experience, with detection rates from 50-90%. This paper will review the normal anatomy of fetal heart observed in the FCV and differential diagnosis of the congenital fetal heart anomaly based on the abnormal findings in the FCV: situs and axis, septal abnormality, chamber size abnormality and abnormal cardiac vessels.