Solution: Fetal cardiac evaluation is difficult and the main thing for you to realize when you see this is that something is very wrong. Next, you need to try to categorize it and make sure that the patient is seen by at a high risk OB center with a full cardiac evaluation. This is a case of transposition of the great vessels. The things to look for in these patients is that the great vessels will arise from the ventricles in a parallel fashion and the pulmonary artery will arise from the left ventricle and the aorta will arise from the right ventricle. There is often an associated VSD, as there is in this case. These patients will be cyanotic at birth, especially after the PDA closes and identifying during pregnancy allows appropriate management at birth, including Prostaglandin administration to keep the ductus open and ultimately surgical correction.