We report the case of an adolescent boy who had progressive respiratory distress and cardiovascular compromise after striking his chest against his bicycle handlebars. An echocardiogram in the emergency department revealed a large ventricular septal defect. The boy did well after emergent operative repair and subsequent replacement of a torn tricuspid valve. The characteristics of ventricular septal defects from blunt trauma are briefly discussed. © 2007 Lippincott Williams & Wilkins, Inc.