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Echocardiography is the gold standard for the comprehensive diagnosis of cardiac septal defects (CSDs). Currently, echocardiography diagnosis is primarily based on expert observation, which is laborious and time-consuming. With digitization, deep learning (DL) can be used to improve the efficiency of the diagnosis. This study presents a real-time end-to-end framework tailored for pediatric ultrasound video analysis for CSD decision-making. The framework employs an advanced real-time architecture based on You Only Look Once (Yolo) techniques for CSD decision-making with high accuracy. Leveraging the state of the art with the Yolov8l (large) architecture, the proposed model achieves a robust performance in real-time processes. It can be observed that the experiment yielded a mean average precision (mAP) exceeding 89%, indicating the framework's effectiveness in accurately diagnosing CSDs from ultrasound (US) videos. The Yolov8l model exhibits precise performance in the real-time testing of pediatric patients from Mohammad Hoesin General Hospital in Palembang, Indonesia. Based on the results of the proposed model using 222 US videos, it exhibits 95.86% accuracy, 96.82% sensitivity, and 98.74% specificity. During real-time testing in the hospital, the model exhibits a 97.17% accuracy, 95.80% sensitivity, and 98.15% specificity; only 3 out of the 53 US videos in the real-time process were diagnosed incorrectly. This comprehensive approach holds promise for enhancing clinical decision-making and improving patient outcomes in pediatric cardiology.