The optimal surgical management of ventricular septal defects (SVD) in infancy and particularly in small babies, still remains controversial. Seventy-six infants with VSD as the major cardiac lesion were operated upon from March 1978 to December 1981. Forty-three underwent primary repair with a 9.3% mortality rate. Pulmonary artery banding (PAB) was performed in 33 infants without mortality. Sixteen of them had subsequent debanding and VSD closure, also without mortality. Based on our own experience, our current recommendations are as follows: PAB in severely ill infants under 3 months of age, in infants with multiple or "Swiss-cheese type VSD" and in some cases of VSD with associated anomalies. Early debanding and correction, except in cases with multiple VSDs. Primary repair in infants aged more than 3 months and in some selected younger cases, according to the anatomical location of the defect.