Congenital heart disease (CHD) is the most frequent form of major birth defects in newborns affecting close to 1% of newborn babies (8 per 1,000). With the progress in the management of CHD, both medically and surgically, the evaluation and follow-up of the myocardial performance became a necessity.Echocardiography has evolved as a well-established tool for the non-invasive evaluation of regional and global myocardial function. However the existing techniques have two important limitations. First, the 2-D echocardiographic imaging using a grey-scale does not always provide effective evaluation of regional wall motion and second, is the difficulty of accurately assessing right ventricular size and function. Search for superior techniques to quantify regional and global myocardial function has therefore continued. Tissue Doppler echocardiography is a new ultrasound technique that uses shifts in Doppler frequencies for quantifying myocardial motion. Tissue velocity imaging has evolved not only as a useful technique for quantifying the nature and the extent of myocardial dysfunction in several diseased states, but it also forms a basis for more sophisticated analytical techniques such as strain rate imaging. This essay reviews the concepts, techniques and clinical applications of tissue Doppler imaging, current status in clinical pediatric cardiology, together with its limitations and the potential future applications.