The past three decades have seen echocardiography evolve into a cornerstone of modern cardiac investigation. Gradually, additional ultrasound-based techniques have been invented, investigated, and then integrated. A more recent development in echocardiography is three-dimensional imaging, which has permeated every aspect of traditional cardiac ultrasound. It is more than simply the latest addition to "standard" echocardiography and almost has developed into an independent imaging modality, encompassing gray-scale acquisitions, color Doppler, stress, contrast, and now even transesophageal imaging. Its utility in research has long been established, but more recent investigation has focused on its incorporation into daily clinical practice. This article summarizes the available techniques, puts them in a clinical context, and examines recent research. © 2008 Springer.