Aortic hypoplasia and right ventricular outflow tract obstruction in a young man with uncontrolled hypertension

We report the case of a 35-year-old man who presented to hospital with symptomatic uncontrolled hypertension. He had no other conventional cardiovascular risk factors, but did have previous cataract surgery and patent ductus arteriosus repair. Echocardiography revealed normal valves, right ventricular outflow tract obstruction, and heavy calcification of the aortic root compromising luminal diameter. Pulmonary angiography confirmed supravalvular and subvalvular pulmonary stenosis. Aortography showed hypoplasia of the entire aortic trunk extending into the iliac arteries, but without involvement of other major branches. A possible unifying diagnosis, with the combination of aortic hypoplasia, pulmonary artery stenosis, patent ductus arteriosus, and cataracts, was believed to have been congenital rubella syndrome. Although associated with numerous cardiovascular abnormalities, aortic hypoplasia is an extremely rare manifestation of congenital rubella that, to our knowledge, has been reported in only two cases in the literature to date.