Indications are divided into those in infancy (before completion of 1 year of age) and those after that.

Infancy-

1. Congestive heart failure not responding to medical treatment. If heart failure responds to medical treatment, we can wait and watch as the VSD size may decrease in some patients.

2. Pulmonary artery pressure more than half of systemic. Here, we can wait till 6 months of age to see whether it regresses. If it does not, then surgery has to be done before the age of 1 year, as after that, the PA pressure may become very high and the case may become inoperable.

After infancy-

1. Pulmonary blood flow twice or more than systemic. In this situation, early surgery is preferred now, preferably before 2 years of age.

2. Aortic regurgitation is an indication for surgery, even with lesser levels of shunts.