A project was developed by Heart Hospital in Massa, supported by Cuore un Mondo Association and Tuscany Region, for medical cooperation with Balkan Countries in diagnosis and care of congenital heart diseases. First step was to set up a telemedicine network aimed at multi-center cooperative medical decision making. Tele-echocardiography was initially implemented at pediatric clinical centres of Banja Luka, Rijeka and Tirana, using videoconference equipment for transmitting over Internet sequences of medical images. Actually videoconference systems are expensive, use proprietary technology and have limited functions. To overcome these limitations we designed a low-cost Open-Source-based device allowing both on-line streaming of video signals for real-time interaction and off-line transmission of diagnostic images (DICOM and not) in addition to videoconference and image storage/management functions. This device is also challenging for use also in remote Countries not able to acquire expensive medical technology.