Cardiac disease has emerged as the leading cause of maternal death during pregnancy in the UK. Its incidence has been rising in the past two decades, largely due to increasing mortality from acquired heart disease, which currently exceeds mortality from congenital heart disease. According to the Confidential Enquiry, better care could have altered the course of 40% of the deaths from cardiac causes. Management of these patients is critical, because any maternal complication has major impacts on surviving children. Improvements in maternal cardiovascular medicine require concerted efforts through interdisciplinary collaboration of all specialties caring for pregnant cardiac patients. One important area for improvement is on how to identify and evaluate those at highest risks of pregnancy-related cardiac complications. Most assessments and clinical guidelines for the management of pregnant women with heart disease have been based on retrospective lesion-specific information. Direct evaluation of cardiac function during pregnancy may add further information, improving the cardiac care we can provide to individual pregnant cardiac patients. More research in this area is urgently needed. We also propose that improvement in training, research and exposure to the subspecialty of maternal cardiovascular medicine is needed to continue to raise standards of care for this patient population.