Ventricular septal defect (VSD) is the second most commonly occurring congenital heart defect in adults. The incidence in adults is 10 %, as most defects usually close during early childhood. Mortality increases with age, and 75% at the age of 60. Symptoms and clinical presentation depend mainly on the size of the VSD. Patients with small VSDs usually remain asymptomatic. Larger VSDs can cause hemodynamic compromise, increased risk of infective endocarditis and reversal of shunt leading to Eisenmenger syndrome.