The presence of aortic regurgitation (AR) in the setting of the ventricular septal defect (VSD) has always been a management challenge. A 21-year-old male patient presented to the Cardiovascular surgery department with a restrictive perimembranous VSD with severe aortic regurgitation (AR). VSD was first diagnosed at 3 years of age. The surgical correction was decided when he was symptomatic of severe aortic regurgitation. Trans-aortic approach was performed to close the ventricular septal defect and correct the aortic regurgitation simultaneously. Surgical management was followed by a complete heart block.