In case of small defects surgical treatment is not indicated because spontaneous closure may occur before one to two years of age. Patient is treated for congestive heart failure, repeated chest infections, prevention and treatment of anaemia and infective endocarditis. Surgical treatment requires open heart surgery with cardiopulmonary bypass and is indicated in
(i) Congestive heart failure in infancy not responding to medical management
(ii) If left to right shunt is large (pulmonary flow more than twice the systemic flow)
(iii) If there is associated pulmonic stenosis, pulmonary arterial hypertension or arotic regurgitation.
Operative treatment consists of closure with dacron patch sewn over the opening.