Background: Two fetuses with endocardial fibroelastosis, one with critical aortic stenosis and one with high-output cardiac failure due to chorioangiomatosis, are presented to evaluate the correlation between Doppler echocardiographic findings, the fetal clinical condition and the anatomical substrate found at postmortem. Methods: Doppler measurements of cardiac function (systolic, diastolic and global) and a cardiovascular score incorporating five parameters of fetal well-being were recorded. Results: In the fetus with critical aortic stenosis, the cardiovascular score was diminished, there was no hydrops, the systolic and global cardiac function indices were within normal limits but the diastolic function indices were abnormal. The fetus with high-output cardiac failure was hydropic, the cardiovascular score was diminished and abnormal Doppler indices of systolic, diastolic and global cardiac function were found. In both fetuses, abnormalities in the measured Doppler parameters were found consistent with clinical cardiac dysfunction and the postmortem findings. Conclusion: Recognition of abnormal diastolic function Doppler indices may assist in earlier identification of fetal cardiac compromise. Copyright © 2010 S. Karger AG.