 ventricular septal defect aortic regurgit clinic hemodynam surgic consider clinic hemodynam angiograph anatom find fifteen patient ventricular septal defect complic aortic regurgit present combin malform aortic regurgit acquir prolaps aortic valv leaflet septal defect strateg locat septal defect relat aortic leaflet appear develop complic size defect magnitud shunt onset aortic regurgit occur earli childhood sever care observ patient defect indic appear aortic regurgit rapid progress sever left ventricular failur uncommon ventricular septal defect aortic regurgit distinguish cardiovascular abnorm produc wide puls pressur continu to-and-fro murmur cardiac catheter thorac aortographi diagnost procedur help differenti oper treatment ventricular septal defect aortic regurgit review basi report suggest plan surgic manag present 