The aim of this study was to evaluate usability and accuracy of three-dimensional rotational angiography (3DRA) during interventions of the aorta in congenital heart disease (CHD). 3DRA is an accurate, encompassing and fast imaging technique in the cath lab. However, there is only few published data about its use during interventions in CHD. Between January 2010 and January 2014, 3DRA was performed in 77 patients with aortic issues: in 65 % cases, an intervention was performed, of which 72 % had aortic isthmus stenosis. Data were obtained retrospectively. The accuracy of 3DRA was evaluated on the basis of comparative measurements (n = 60) of the aortic diameter between 3DRA and conventional biplane angiography. Measurements presented a high accuracy with an average deviation of 3.89 % [±3 %] and a significant correlation of r = 0.99 after Pearson (p < 0.0001). Clinical benefit was assessed using a five-point Likert scale and could be shown in 98 %. Comparison with a control group showed a reduced fluoroscopy time from 10.2 to 8.30 min (median, p < 0.01) and decreased radiation dose of 0.18 compared to 0.56 Gy cm2/kg (median, p < 0.02). The use of 3DRA in patients with aortic anomalies has advantages in comparison with conventional angiography. It improves diagnostic accuracy, and 3D guidance enables a faster and simplified intervention with enhanced patients’ safety and the potential to reduce radiation dose.