Nonpenetrating traumatic ventricular septal defect is rare. A triad of blunt chest trauma, holosystolic precordial murmur, and ECG abnormalities should suggest the diagnosis. Surgical repair, when indicated by progressive failure, rising pulmonary artery pressures, or significant (2:1 or larger) left-to-right shunt, has been shown to be very effective. Optimally, a period of several weeks from the injury should elapse before operative intervention is undertaken. Intra-aortic balloon pump may be helpful to stabilize patients acutely, and, in selected instances, allow delay of surgical repair so that the tissue around the defect may hold sutures more securely.