MicroRNAs (miRNAs) are a class of small non-coding RNAs that are endogenously transcribed and processed into approximately 21- to approximately 23-nucleotide products. They are believed to function predominantly as sequence-targeted modifiers of gene expression through inhibition of post-transcriptional processes, including messenger RNA degradation and translational repression. Rapid expansion of functional studies of miRNAs in recent years has established a new paradigm in which miRNAs 'fine-tune' gene expression in complex biologic networks. In this review, we summarize the role of miRNA in heart development and cardiac pathogenesis, and discuss the implication of miRNAs as innovative therapeutic approaches for cardiovascular diseases.