**10. Conclusions**

Smaller VSDs may self-resolve and the majority of the patients do well without intervention. On the other hand, recognition of unrestrictive defects, and prompt medical and surgical intervention may prevent development of irreversible pulmonary vaso-occlusive disease. Newer therapeutic options such as a minimally invasive approach as well as catheter based closures are appealing and can dramatically improve cosmetic outcomes in many of these patients. Development of newer devices and ongoing trials provide promise in non-surgical approach for VSD closure. Adult patients with Eisenmenger's syndrome continue to present a challenge due to increased morbidity and mortality. Specialized targeted anti pulmonary arterial hypertension therapies with endothelin receptor antagonists, phosphodiesterase 5 inhibitors and prostacyclins show improved exercise capacity and hemodynamics in this patient population.
