Background: Recent advances in the field of nonsurgical, transcatheter interventions in pediatric cardiology, have metamorphosed the management of congenital heart disease. There is a significant change, with adoption of new techniques. Objective: To study the changing pattern of cardiac catheterization in congenital heart diseases over the last 3 decades. Materials and Results: This is a retrospective, single center study of 8,708 cases who underwent cardiac catheterization for various congenital heart diseases between April 1981 to Dec 2015. Age group ranged from 14-hour old neonate to 18 years. The study included 4,754 (54.6%) boys and 3,954 (45.4%) girls. Various clinical details were noted with particular emphasis on indication for catheterization, age, gender and details of interventions. Commonest conditions catheterized were atrial septal defects 2,015 (23.1%), ventricular septal
defects 1,653 (18.9%), patent ductus arteriosus 1,179 (13.5%), Tetralogy of Fallot 1,102 (12.7%), Pulmonary stenosis 882 (10.1%), rest were coarctation of aorta and other complex conditions. Patients were divided into three groups – Group-1(1981-1997), Group-2(1998-2006) and Group-3(2007-2015). Results showed that Group-1 mainly comprised of diagnostic catherisations. Group 2 and 3 showed both diagnostic and therapeutic indications for catheterization and the number of interventional catheterizations increased from 28%(n=652) in Group-2 to 56%(n-1439) in Group-3 (p<0.001) and number of diagnostic catheterization decreased from 98% in Group-1 to 72%(n=1677) in Group-2 to just 44%(n=1150) in Group-3(p < 0.001). Conclusions: There is significant shift from diagnostic s to therapeutic interventions in the last 3 decades. Availability of expertise and infrastructure have been mainly responsible for this trend.