A 2-month-old boy is found to be in congestive heart failure manifested by tachypnea, tachycardia and diaphoresis with poor weight gain. The physical findings suggest a ventricular septal defect (VSD). Management should include:

c. Medical treatment only with digitalis and diuretics 

e. If a restrictive VSD is found, spontaneous closure is a possibility and operative repair should be delayed

Large VSDs present at 6–8 weeks of age when the normally elevated pulmonary vascular resistance falls, allowing an increase in the left-to-right shunt. Since roughly half of all VSDs undergo spontaneous closure, particularly with restrictive defects, the initial management is medical. The diagnosis is confirmed by echocardiography and cardiac catheterization. Advanced pulmonary vascular changes do not occur usually until 2 years of age and banding is only rarely indicated for palliation for multiple complex muscular VSDs.