Background: Aortic valve insufficiency with ventricular septal defect is usually treated by plication of the commissures. However, long-term deterioration is common. Aim of the Study: To assess the results of aortic repair with VSD closure in patients with VSD and mild to moderate aortic regurgitation and its effect on post operative course, postoperative LV dimensions and functions, this is to decide which degree of aortic regurgitation needs to be repaired in association with VSD closure. Patients and Methods: The current study included 25 patients having VSD associated with mild to moderate aortic regurgitation who will undergo surgical closure of the VSD with repair of their aortic valve. All cases were subjected to clinical, radiological, echocardiographical assessment and surgical repair followed by postoperative assessment of LV changes. Results: All children were subjected to patch closure of VSD except for severe cases of Al where VSDs were closed and aortic incompetence were treated by valvuloplasty. Postoperatively, there was no peri-immediate or late postoperative mortality. There was successful drop in pulmonary systolic pressure in addition to a significant improvement of left ventricular echocardiographic data in all groups regarding LVESD, LVEDD, EF, SWT (though statistically insignificant), PWT and LV muscle mass. Conclusion: Early detection and management of VSD associated with Aortic valve incompetence is helpful in management of these children with best results.