Infants with small ventricular septal defect (VSD) are asymptomatic. VSD is classified as perimembranous or sub-aortic, muscular or trabecular, inlet and outlet types. Outlet VSDs are known as sub-arterial, sub-pulmonary or doubly committed VSD. Majority of small perimembranous and muscular VSDs close spontaneously. VSD is acquired when septum ruptures due to infarction or trauma. Loud pansystolic murmur with thrill at left sternal border without cardiomegaly and normal ECG is characteristic of small VSD known as Maladie de Roger. When VSD is large, infants are symptomatic in the form of heart failure and recurrent lower respiratory infection because of high pulmonary flow. Closely split S2 is with loud P2, left ventricular S3 and a pansystolic murmur over left sternal border with a mitral diastolic flow murmur. ECG shows biventricular hypertrophy. X-ray shows cardiomegaly with LV contour, LA enlargement and pulmonary plethora. Echocardiogram with color Doppler delineates the site, size and type of VSD and pulmonary arterial pressure. Uncorrected cases develop Eisenmenger’s syndrome, right ventricular outflow obstruction or aortic regurgitation (AR) caused by prolapse of one or more aortic cusp through the VSD. AR is more common in outlet VSD and is also progressive. It is diagnosed by presence of an early diastolic decrescendo murmur over left sternal border along with a pansystolic murmur of VSD. Besides decongestive therapy early closure of VSD (surgical or nonsurgical) is advised. Rarely VSD communicate from left ventricle to right atrium called Gerbode shunt or left ventricular to right atrial canal.