A patient of moderate VSD in chronic CCF develops clubbing with no cyanosis. Diagnosis is

SHUNT REVERSAL / EISENMENGER SYNDROME: Refers to patients with the septal defect in which blood is shunted paially or completely from right to left as a result of the development of pulmonary vascular disease resulting in apparent cyanosis.Long-standing pulmonary edema is characterized by cyanosis, dyspnea.New onset clubbing without cyanosis in a patient with congenital hea defects indicates the development of SABE .Pulmonary aerial hypeension commonly occurs in large non-restrictive VSD and is unlikely in moderate VSD.