Purpose: The International Quality Improvement Collaborative (IQIC) for CHD has aimed to improve the quality of care and surgical outcomes in low-and middle-income countries (LMICs). Little is known about prenatal and postnatal diagnostic imaging infrastructure gaps for CHD in LMICs. Methods: A survey was administered to all sites participating in IQIC using a REDCap database. This survey included assessment of imaging infrastructure and workforce. Responses were summarized as medians [25th, 75th percentiles] for continuous variables and percentages for categorical responses. Results: Of 64 IQIC participating sites, 37 sites (58%) in 17 countries participated in the survey. Program size and geography varied considerably: less than 250 cases (n=13), 250 to 500 cases (n=9), greater than 500 cases (n=15); Americas (n=13), Asia (n=18) and Eastern Europe (n=6). All programs had access to transthoracic echocardiography with a median of 3 [2, 4] echo machines in programs with less than 250 cases and 10 [4, 15] in programs with greater than 500 cases. Almost all centers were equipped to conduct sedated echocardiography for infants and young children (97%) and able to obtain emergency echocardiograms within 1 hour (92%). Most centers reported intraoperative availability of transesophageal (86%) and epicardial echocardiography (89%). The median cost of one echo was $26 US dollars [17, 52]. The cost was similar in Americas and Eastern Europe and lower in Asia. Most (81%) programs had cardiac CT while only 54% had cardiac MRI imaging availability. A third of the programs reported limitations that restrict the number and complexity of cardiac imaging studies performed. These included lack of portable echo machines, neonatal probes and access to cardiac MRI and CT. Only 16 of 35 (46%) centers performed fetal echocardiography; 7 in Asia, 5 in the Americas and 4 in Eastern Europe. Only 24% of centers screened newborns for CHD at birth and only 53% reported organized community screening for CHD. Most of those who screened newborns used pulse oximetry. Conclusions: Imaging is the backbone of diagnostic assessment for patients with CHD. Although access to echocardiography is available in most LMICs, advanced cardiac imaging and specialized echocardiography tools are not always available. Treatment for CHD, especially in newborns and complex cases is limited by access to diagnostic tools in LMICs.