In the last decades the introduction and development of echocardiography allowed a significant improvement in the diagnosis as well as in the morphological and functional evaluation of several heart diseases, and today many therapeutic decisions are taken based on the results of the echocardiographic examination. One of the most important development in the field of echocardiography is three-dimensional imaging, which has evolved from the slow and labor-intense off-line reconstruction techniques to the faster and simpler real-time volumetric imaging, which has the potential to be integrated in routine clinical practice. One of the major proven advantages of real-time three-dimensional echocardiography is the evaluation of left ventricular volume, mass and function, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. In this review we discuss the state-of-the-art and anticipate future developments of real-time three-dimensional echocardiography that are relevant to its application to the left ventricle.