Pediatric cardiac surgery has been available for several decades. With advances in recent years, the majority of children born with congenital heart disease, if repaired in time, are expected to lead normal productive lives. This privilege of early diagnosis and timely management is restricted to children in developed countries only. The majority of children born with congenital heart disease in developing countries do not get the necessary care, leading to high morbidity and mortality. Several reasons exist for this state of affairs. Most centers for congenital cardiac surgery are located in developed countries, whereas most children requiring cardiac surgery do not live in these countries. In less privileged regions of the world, the high cost of cardiac surgery makes it unaffordable for the families of these children. Furthermore, issues such as late presentation of cases, associated comorbid conditions, understaffing of units and limited resources contribute to suboptimal outcome in those who undergo surgery. This review discusses the current status of pediatric cardiac surgery in developing countries and the reasons for it. Some of the strategies for improvement, in the wake of limited resources, are suggested. Often, the resources are not only limited but improperly utilized.