Although great progress in pediatric cardiac surgery has been achieved in recent years, significant gaps still persist between our pediatric cardiac surgery centers and international centers compared with developed countries, prominent gaps exist in surgical treatment of certain types of complex congenital heart diseases. The current study highlights how the practice of pediatric cardiac surgery in the Pediatric Cardiac ICU, Children’s Hospital, Cairo University compares with first-world standards and outline some of the problems faced by pediatric cardiac services in developing nations. Our study included a total of 234 patients admitted to the Cardiac Intensive Care Unit (CICU), Children’s Hospital, and Cairo University during the 6 months period between 1/1/2008 to 30/6/2008. Out of the included 234 patients, 121 underwent cardiovascular surgeries and 113 underwent cardiac catheterization. Retrospective analysis of the data of the patient’s records was done. Types of cardiothoracic surgeries included in this retrospective study were either closed which was done in 36.4% of cases or open which was done in 63.6% of cases. Type of procedure was either corrective surgery which was done in 82.6% of cases, palliative surgery in 12.3% of cases and others in 5.1% of cases and the mortality rate was 26% and the main cause of death was found to be surgery-related (24% of cases).The most commonly performed operation in the current study was VSD closure followed by PDA closure followed by arterial switch operation. Truncus arteriosus Correction has the worst outcome with 100% mortality. The best outcomes were reported with closure of PDA, TAPVR, Fontan operation, atrial switch and ASD closure with zero mortality rates. Post-operative complications were reported in 63% of cases and the most striking finding was the high prevalence of pneumonia as the commonest complication as it was encountered in 35.5% of cases. Regarding the cardiac catheterization, our study included 113 cases undergoing catheterization which was diagnostic in 48 cases (42%) or interventional in 65 cases (58%). Balloon valvuloplasty was the commonest procedure done. Death was encountered in only 12% of cases with hypoxic spells as the most common cause of death. Complications developed in 30% of cases and the commonest were vascular complications. As a conclusion, it is important to point out that mortality rate of cardiothoracic surgery in our study was 26 % and surgery-related causes were the most common cause of death. Mortality rate of cardiac catheterization was 12% and hypoxemic spells were the most common cause of death. The rate of complications following cardiothoracic surgery was 63% and the most frequent complication was infections particularly pneumonia. The rate of complications following cardiac catheterization was 30% and the most frequent complication was vascular complications.