【】 Objective To evaluate the value of screening and diagnosis of fetal severe cardiac malformation in the first trimester. Methods ContinuousS pregnant women coming to our hospital from February 2015 to February 2018 for 11～13₊₆ weeks scanning were included in this study．Fetal heart was observed by four-chamber (4CH) view and three-vessel-trachea (3VT) view combined with color doppler flow imging (CDFI) in order to screen severe cardiac malformation. Follow up and the final result were recorded. Results A total of 2021 cases were included in the study. There were 19 cases with severe cardiac malformation were detected, 4 cases were missed, and the detection rate reached 82.6% (19/23). All cardiac abnormalities were abnormal in 4CH and/or 3VT views. Conclusions It is an effective method to screen fetal severe cardiac malformation by using 4CH and 3VT view and CDFI at the first trimester after the rigorous training of ultrasound physicians.