Objective:
As is commonly understood, the clinical course of small peri-membranous VSD is an initial loud pan systolic murmur that progressively softens and eventually disappears as the VSD closes. These signs are confirmed echocardiographically. However the condition where the murmur becomes silent clinically yet a VSD persists echocardiographically has not been described before.

Methods & Results:
I reviewed more than 120 of my peri-membranous VSD pts.on serial follow up and describe 8pts(aged8mths-10yrs) that have had spontaneous clinical closure of small peri-membranous VSD with the progressive disappearance of the pan systolic murmur,(independently observed) but have persistent echocardiographic features of VSD (based on 2D,colour flow and continuous wave Doppler with complete or incomplete envelope).These pts. have now been followed up for 9mths-6yrs and remain well.

Conclusion:
Like silent PDA, silent VSD cannot be heard clinically but exist on echocardiography. Because anatomically a VSD remains, it’s clinical significance needs to be further established.