Objectives: The main objective is to showcase the overall pattern and distribution of cardiac diseases diagnosed by echocardiography and to highlight the difficulties encountered in delivering a Pediatric Cardiology/Cardiac Service at University of Nigeria Teaching Hospital. Materials and Methods: There were 308 children seen from July 2011 to June 2016. Their echo reports and case notes were retrieved and analyzed using SPSS version 20 (Chicago). Results: Their age range was from 3 days to 18 years mean (6.5 ± 4.2 years). One hundred and seventy‑five (57.0%) were male and 133 (43.0%) were female with male: female ratio of 1.3:1. Of these, 211 had structural heart disease with 154 being congenital heart disease (CHD) and 57 were acquired heart disease, giving the prevalence of 0.44% and 0.16%, respectively. Isolated ventricular septal defect was highest acyanotic CHD with 44.1%, while tetralogy of Fallot was highest with 14.3% in cyanotic group. Some rare anomalies were also seen; one case of left ventricular noncompaction syndrome, Eisenmenger’s syndrome, and Ebstein’s anomaly representing 0.6%, respectively. The outcome was satisfactory with 35.5% receiving surgery with 7.7% mortality. The cost of procedures and dearth of interventional equipment were some of the challenges encountered. Conclusion: Although there exists low prevalence of echo diagnosed cardiac disease, a good number of them could not get surgical intervention due to cost.