Subpulmonic VSD's NEVER CLOSE whatever be the size. The issue here is mainly related to the state of the Aortic valve and this is where the controversy arises. Some authors believe that if there is significant valve prolapse then it should be operated upon in order to prevent further distortion of the valve. Others believe that surgery should be performed if Aortic regurgitation is noticed.I follow the second option. If there is no leakage in Aortic Valve then a yearly echo is done on a regular basis.