Adults with congenital heart disease (CHD) are rapidly increasing in numbers in developed countries where facilities for interventions for CHD are available to infants and children. Over 90 % of children survive to adulthood in these countries. However, less than 50 % of children born in developing countries undergo any form of intervention due to nonavailability of paediatric cardiac centres. Prevalence of CHD in adults is estimated at 3000 per million population in developed countries. Such data is not available from developing countries, but prevalence is likely to be much lower due to early attrition. In these countries, adult population with CHD mostly consists of relatively milder forms of CHD with a very small proportion of post-operated patients. Specialized centres for care of adults with CHD are sparse or nonexistent in most developing countries, although the situation is changing for the better in some of these countries. Major challenges to care of adults with CHD include lack of trained persons, low levels of awareness about the disease and lack of government interest. Sustainable strategies which are practical in the local environment are required to deal with these challenges. An urgent need is to initiate training of cardiologists and other team members, required for optimal care of these patients. Special clinics for adults with CHD, run by the trained staff, can be incorporated into already operational cardiac centres. Formation of expert groups and patient support groups will help to formulate local guidelines and to pursue advocacy with the government. Maintenance of registries for adults with CHD is necessary to generate data on disease burden and to set research priorities. It is likely that care for adult CHD will be delivered in less than ideal settings considering the limited resources available.