Congenital heart disease is the most common congenital anomaly seen in children. Many cases require early surgical intervention. We studied children suffering from congenital heart disease who were advised surgery in pediatric OPD to see how many of them actually underwent surgery during follow up and reasons behind not being able to undergo one. Only 10.6% of our study population actually underwent surgery after being advised. The major reasons behind not undergoing surgery in the remaining children were unaffordability (37.3%), pediatric cardiac surgery not being available locally (37.3%) and long waiting lists at the pediatric cardiac surgery centres (20.3%). Hence, the utilization and availability of pediatric cardiac surgery for children with CHD is very poor in this region of the country.