Introduction: Congenital Heart Disease (CHD) refers to structural or functional heart disease present at birth. CHD continues to cause morbidity and mortality in Fiji. There is no published data on CHD in the Pacific in the last 15 years. Unpublished data by Mataika. R, 2012 (12) estimated the incidence of CHD at Colonial War Memorial Hospital (CWMH) was ~ 0.5% or 4.9/1000 live births. This study aims to collect and document data on the incidence, types, management and outcomes of CHD, a platform upon which decisions for policy and practice development for CHD screening and management in Fiji can be made. Method: This is a five-year descriptive, retrospective, single-centre study at CWMH. Results: The incidence of CHD was 5.8 per 1,000 with an uncorrected incidence of 7.2 per 1,000. Ventricular Septal defects (VSD) and Tetralogy of Fallot (TOF) were the most common acyanotic and cyanotic lesions respectively. The total number of cases of CHDs was 202 and 76 (39%) died within that period. Ninety-five percent of the deaths occurred within the first year of life. Sixty-five percent of these infant mortalities were known acyanotic CHD cases. Forty-six (23%) cases had corrective surgeries. Survival rate for surgery locally was 98%, compared to 100% for those cases that had surgery abroad. Conclusion This study highlights the mortality associated with congenital heart diseases in Fiji and the need for strengthening of surgical management strategies.