The indications to close a ventricular septal defect either percutaneously or surgically are:

1. When the Qp/Qs is > 1.5 and there is LV systolic or diastolic dysfunction causing clinical heart failure.

2. Prior endocarditis

3. When the Qp/Qs is > 1.5 and the pulmonary pressures are no more than two thirds of systemic pressure.

4. When the Qp/Qs is > 2 and there is evidence of volume overload of the LV

5. When acute VSD develops after myocardial infarction

If Eisenmenger’s syndrome is present, closure of a VSD is NOT recommended and can be fatal. In this situation, the only remedy is heart-lung transplantation.