b) for a short time after birth (before the right ventricular pressure has decreased), and c) as a late complication of unrepaired VSD. Confirmation of cardiac auscultation can be obtained by non-invasive cardiac ultrasound (echocardiography). To more accurately measure ventricular pressures, cardiac catheterization, can be performed. Classification Although there are several classifications for VSD, the most accepted and unified classification is that of Congenital Heart Surgery Nomenclature and Database Project. The classification is based on the location of the VSD on the right ventricular surface of the inter ventricular septum and is as follows: Multiple Type 1 Type 1 is sub aortic Type 2 Type 2 also known as perimembranous, paramembranous, conoventricular, membranous septal defect, and subaortic. Most common variety found in 70% Type 3 Type 3 also known as inlet (or AV canal type). Commonly associated with atrioventricular septal defect, found in about 5% Type 4 Type 4 also known as muscular (trabecular) Located in the muscular septum, found in 20%. Can be sub classified again based on the location into anterior, apical, posterior and mid Type: Gerbode Type: Gerbode also known as left ventricular to right atrial communication Due to absence of Atrioventricular septum. Treatment Most cases do not need treatment and heal during the first years of life. Treatment is either conservative or surgical. Smaller congenital VSDs often close on their own, as the heart grows, and in such cases may be treated conservatively. Some cases may necessitate surgical intervention, i.e. with the following indications: Failure of congestive cardiac failure to respond to medications VSD with pulmonic stenosis Large VSD with pulmonary hypertension VSD with aortic regurgitation For the surgical procedure, a heart-lung machine is required and a median sternotomy is performed. Percutaneous endovascular procedures are less invasive and can be done on a beating heart, but are only suitable for certain patients. Repair of most VSDs is complicated by the fact that the conducting system of the heart is in the immediate vicinity. Ventricular septum defect in infants is initially treated medically with cardiac glycosides (e.g., digoxin 10-20 μg/kg per day), loop diuretics (e.g., furosemide 1–3 mg/kg per day) and ACE inhibitors (e.g., captopril 0.5–2 mg/kg per day). Transcatheter closure A device, known as the Amplatzer muscular VSD occluder, may be used to close certain VSDs. It was initially approved in 2009. It appears to work well and be safe. The cost is also lower than