True about V.S.D. is,all except

The VSD is usually single and situated in the membranous or midmuscular poion of the septum. Spontaneous closure is more common in patients born with a small VSD, which occurs in early childhood in most. Main complications are possible development of pulmonary vascular obstruction, RV outflow tract obstruction, aoic regurgitation, or infective endocarditis. (Harrison's Principles of internal medicine, 18 th edition, page 1923 )