From October 1991 to December 1995, 6 patients with a ventricular septal defect and aortic incompetence underwent surgical repair in our department. Mean age was 21 years (range, 16 to 27 years). The ventricular septal defect was subcristal in 3 patients and subpulmonary in 3. The aortic valve was bicuspid in 1 patient. Aortic incompetence was mild in 1 patient, moderate in 2 and severe in 3. Closure of the ventricular septal defect and aortic valve replacement were performed in 4 patients. Operation consisted of ventricular septal defect closure and valvuloplasty in 2 patients. There were no perioperative or late deaths. All patiens retained normal sinus rhythm. No heart block was found. Mean follow-up was 31 months (range, 7 to 56 months). In all 6 patients, all clinical signs of aortic inffuciency disappeared, and only minimal aortic regurgitation could be demonstreated by color Doppler imaging in one patient who had valvuloplasty. We conclude that aortic regurgitation itself tends to progress. The older the patients, the greater the secondary cuspal changes; therefore, the prognosis of valvuloplasty in older patients is not considered to be satisfactory. In adults, aortic valve replacement at the initial operation should be the procedure of choice.