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A ventricular septal defect (VSD) is an opening in the interventricular septum that allows blood to pass from the left ventricle into the right ventricle, increasing pulmonary blood flow and cardiac workload. VSDs range from tiny muscular defects that often close spontaneously to large perimembranous or muscular defects that cause significant left-to-right shunts and symptoms in infancy. Clinically, small VSDs may be asymptomatic and detected only by a characteristic holosystolic murmur, while larger defects commonly present with tachypnea, poor feeding, diaphoresis during feeds, failure to thrive, and recurrent respiratory infections.

Diagnosis relies on transthoracic echocardiography to determine defect size, location, and shunt volume; additional tests include chest X-ray, ECG, and cardiac catheterization when planning intervention. Management depends on defect size and symptoms: conservative observation for small defects, medical therapy for heart failure or pulmonary overcirculation, and transcatheter device closure or surgical repair for moderate-to-large defects or complications such as pulmonary hypertension or failure to thrive. Untreated large VSDs risk progressive pulmonary vascular disease and Eisenmenger physiology, so timely specialist referral and follow-up are essential.