A descriptive study was undertaken to document the pattern, management and immediate outcome of surgery in children with congenital heart disease referred to the cardiology clinic. On presentation a physical examination, chest radiogram, electrocardiogram and cross-sectional echocardiogram were performed. Two hundred and eighty-six children seen over a period of 18 months between 1990 and 1992 were included in the study. Their ages ranged from 2 days to 15 years (median 23 months) and the male to female ratio was 1:1.1. The predominant lesions were ventricular septal defect (32.9%), tetralogy of Fallot (19.6%) and patent ductus arteriosus (11.9%). Seventy-three children (26%) had surgery, with a mortality of 5.5%. There was a pattern of late presentation (68.2% after 1 year of age) accompanied by a high rate of complications. There was also an under-representation of lesions which have a high mortality in infancy.