Cardiac disease is an uncommon but potentially serious medical complication of pregnancy. It is an important cause of preventable maternal and perinatal mortality and morbidity. A multidisciplinary approach involving close liaison and collaboration between the obstetrician, cardiologist, anaesthetist, neonatologist, paediatric cardiologist and, if appropriate, the cardiothoracic surgeon, is essential to achieve optimal care in such pregnancies. The principles of management that ensure a good pregnancy outcome include pre-pregnancy counselling, recognition of risk factors, early diagnosis, close obstetric and medical surveillance, anticipation and prompt identification and treatment of complications, the appropriate use of drugs, surgical intervention, and timely delivery of the baby.